Provider Demographics
NPI:1699201723
Name:BURBANK ANESTHESIA ASSOCIATES A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BURBANK ANESTHESIA ASSOCIATES A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-588-4150
Mailing Address - Street 1:PO BOX 893520
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-3520
Mailing Address - Country:US
Mailing Address - Phone:818-588-4150
Mailing Address - Fax:
Practice Address - Street 1:2211 W MAGNOLIA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1753
Practice Address - Country:US
Practice Address - Phone:818-588-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty