Provider Demographics
NPI:1497796320
Name:WESTERN ANESTHESIA MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:WESTERN ANESTHESIA MEDICAL ASSOCIATES INC
Other - Org Name:MISSION VIEJO ANESTHESIA CONSULTANTS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PONNAPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIMADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-582-9624
Mailing Address - Street 1:PO BOX 8422
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-8422
Mailing Address - Country:US
Mailing Address - Phone:503-372-2740
Mailing Address - Fax:503-372-2754
Practice Address - Street 1:27700 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6426
Practice Address - Country:US
Practice Address - Phone:949-364-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082380Medicaid
W14375Medicare PIN