Provider Demographics
NPI:1083130553
Name:ADVANCED ANESTHESIA SPECIALISTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA SPECIALISTS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-348-7253
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 500B
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-348-7253
Mailing Address - Fax:
Practice Address - Street 1:4500 TRADE CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8716
Practice Address - Country:US
Practice Address - Phone:818-348-7253
Practice Address - Fax:818-348-7012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED ANESTHESIA SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty