Healthcare Provider Details

I. General information

NPI: 1558865840
Provider Name (Legal Business Name): CORONA ANESTHESIA GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

PO BOX 80181
CITY OF INDUSTRY CA
91716-8181
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax: 310-379-4856
Mailing address:
  • Phone: 310-321-0143
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: IRV EDWARDS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143