Provider Demographics
NPI:1356108831
Name:VASA ANESTHESIA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:VASA ANESTHESIA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:CAVENAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-556-2138
Mailing Address - Street 1:3410 LA SIERRA AVE STE F510
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5270
Mailing Address - Country:US
Mailing Address - Phone:951-556-2138
Mailing Address - Fax:
Practice Address - Street 1:25485 MEDICAL CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6900
Practice Address - Country:US
Practice Address - Phone:951-556-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty