Healthcare Provider Details

I. General information

NPI: 1205253929
Provider Name (Legal Business Name): PRECISION ANESTHESIA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DRIVE SUITE 240
BEVERLY HILLS CA
90210-4240
US

IV. Provider business mailing address

450 N ROXBURY DRIVE SUITE 240
BEVERLY HILLS CA
90210-4240
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-2040
  • Fax: 310-651-2042
Mailing address:
  • Phone: 310-651-2040
  • Fax: 310-651-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: KERRY K ASSIL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-610-2040