Healthcare Provider Details

I. General information

NPI: 1619670445
Provider Name (Legal Business Name): MAHAN ANESTHESIA CALI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

PO BOX 1889
MUNCIE IN
47308-1889
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-5000
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOHAMMAD ABBASIAN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 602-350-0491