Provider Demographics
NPI:1619201712
Name:RELIABLE ANESTHESIA MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RELIABLE ANESTHESIA MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-306-8481
Mailing Address - Street 1:4333 ADMIRALTY WAY WEST HELIX #9
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-306-8481
Mailing Address - Fax:
Practice Address - Street 1:4333 ADMIRALTY WAY
Practice Address - Street 2:WEST HELIX #9
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5469
Practice Address - Country:US
Practice Address - Phone:310-306-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty