Provider Demographics
NPI:1770598294
Name:DIAMOND ANESTHESIA CONSULTANTS
Entity type:Organization
Organization Name:DIAMOND ANESTHESIA CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-626-9922
Mailing Address - Street 1:505 MARIGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2408
Mailing Address - Country:US
Mailing Address - Phone:909-626-9922
Mailing Address - Fax:909-399-9494
Practice Address - Street 1:1211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1103
Practice Address - Country:US
Practice Address - Phone:909-626-9922
Practice Address - Fax:909-399-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26423ZMedicare ID - Type Unspecified