Provider Demographics
NPI:1477638351
Name:DAYDREAM ANESTHESIOLOGY, INC
Entity Type:Organization
Organization Name:DAYDREAM ANESTHESIOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:REINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-887-1580
Mailing Address - Street 1:3900 INLET ISLE DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1604
Mailing Address - Country:US
Mailing Address - Phone:949-887-1580
Mailing Address - Fax:949-612-1845
Practice Address - Street 1:3900 INLET ISLE DR
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1604
Practice Address - Country:US
Practice Address - Phone:949-887-1580
Practice Address - Fax:949-612-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87744207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21889Medicare PIN
MIF85647Medicare UPIN