Opal Anesthesia, LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

OPAL ANESTHESIA, LLC

Practice address

6424 E Broadway Rd Ste 102
Mesa, AZ 85206-1750

Phone

(480) 634-4606

Fax

(480) 452-0582

NPI assigned

Oct 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandie Hernandez

Title

Director of Operations

Phone

(480) 634-4606

Specialties & licenses 1

Addresses

Other names 1

• Opal Anesthesia, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1952909897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "480-634-4606",
            "fax_number": "480-452-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 E BROADWAY RD STE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061750",
            "telephone_number": "480-634-4606",
            "fax_number": "480-452-0582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPAL ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "BRANDIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "480-634-4606"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Opal Anesthesia, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Opal Anesthesia, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Anesthesiology Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Anesthesiology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.