Provider Demographics
NPI:1558925610
Name:PROGRESSIVE ANESTHESIA CONSULTANTS OF CALIFORNIA
Entity Type:Organization
Organization Name:PROGRESSIVE ANESTHESIA CONSULTANTS OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-347-1000
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:3939 RUFFIN RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1804
Practice Address - Country:US
Practice Address - Phone:619-299-9530
Practice Address - Fax:619-296-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty