Provider Demographics
NPI:1255843322
Name:MEDICAL ANESTHESIA ASSOCIATES OF SOUTHERN CALIFORNIA INC
Entity type:Organization
Organization Name:MEDICAL ANESTHESIA ASSOCIATES OF SOUTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-371-1067
Mailing Address - Street 1:PO BOX 250387
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225-0387
Mailing Address - Country:US
Mailing Address - Phone:951-371-1067
Mailing Address - Fax:951-808-5975
Practice Address - Street 1:9461 PITTSBURGH AVE STE B
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9022
Practice Address - Country:US
Practice Address - Phone:909-460-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86743207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty