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NPI Code Detail

MEDICARE: VERDUGO HILLS ANESTHESIA MEDICAL GROUP INC.

MEDICARE: VERDUGO HILLS ANESTHESIA MEDICAL GROUP INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ36723ZOTHERCABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508871385
Entity Type Code : Organization
Provider Name (Legal Business Name) : VERDUGO HILLS ANESTHESIA MEDICAL GROUP INC.
Provider Business Mailing Address
First Line : PO BOX 60790
Second Line :
City : PASADENA
State : CA
Zip : 91116-6790
Country : US
Telephone Number : 626-795-6596
Fax Number : 626-795-8247
Provider Business Practice Location Address
First Line : 1812 VERDUGO BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1407
Country : US
Telephone Number : 818-952-2214
Fax Number : 818-952-4618
Authorized Official
Title or Position : PRESIDENT / AUTHORIZED OFFICIAL
Name : KAREN J MCILVENA
Credential : M.D.
Telephone Number : 626-795-6596
Provider Enumeration Date : 07/30/2006
Last Update Date : 03/25/2015

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