Provider Demographics
NPI:1093049413
Name:ADVANCED ANESTHESIA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:R
Authorized Official - Last Name:FADLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-841-4400
Mailing Address - Street 1:18800 DELAWARE ST
Mailing Address - Street 2:SUITE 670
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1959
Mailing Address - Country:US
Mailing Address - Phone:714-841-4400
Mailing Address - Fax:714-841-4414
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 670
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-841-4400
Practice Address - Fax:714-841-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64236207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty