Provider Demographics
NPI:1689892705
Name:EAST-WEST ANESTHESIA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:EAST-WEST ANESTHESIA MEDICAL GROUP INC
Other - Org Name:ALTERNATIVE ANESTHESIA MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-984-1942
Mailing Address - Street 1:PO BOX 4247
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91617-0247
Mailing Address - Country:US
Mailing Address - Phone:818-984-1942
Mailing Address - Fax:818-786-5417
Practice Address - Street 1:7300 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1902
Practice Address - Country:US
Practice Address - Phone:818-984-1942
Practice Address - Fax:818-786-5417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST WEST ANESTHESIA MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22022207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14208Medicare PIN