Provider Demographics
NPI:1497030522
Name:AESTHETIC ANESTHESIA GROUP INC
Entity Type:Organization
Organization Name:AESTHETIC ANESTHESIA GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMAILI,M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-759-7152
Mailing Address - Street 1:27068 LA PAZ RD # 190
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:858-759-7152
Mailing Address - Fax:310-861-0227
Practice Address - Street 1:910 E BIRCH ST STE 350
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5848
Practice Address - Country:US
Practice Address - Phone:858-759-7152
Practice Address - Fax:310-861-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty