Provider Demographics
NPI:1710924295
Name:SEGREDO PELSANG & HOUSE ANESTHESIA
Entity Type:Organization
Organization Name:SEGREDO PELSANG & HOUSE ANESTHESIA
Other - Org Name:GOLDEN GATE ANESTHESIA SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELSANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-668-1000
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:450 STANYAN STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-668-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0102120Medicaid