Healthcare Provider Details
I. General information
NPI: 1376596650
Provider Name (Legal Business Name): AN ANESTHESIA AND PAIN MANAGEMENT MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/18/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1208 E 5TH ST SUITE 300
BENICIA CA
94510-3502
US
IV. Provider business mailing address
PO BOX 5668
WALNUT CREEK CA
94596-1668
US
V. Phone/Fax
- Phone: 707-748-7248
- Fax: 707-745-9076
- Phone: 707-745-3112
- Fax: 707-745-9076
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207LP2900X |
| Taxonomy | Pain Medicine (Anesthesiology) Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
ARUN
ANAND
Title or Position: PRESIDENT
Credential: MD
Phone: 707-745-3112