Healthcare Provider Details

I. General information

NPI: 1083006928
Provider Name (Legal Business Name): ENCINO ANESTHESIA ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 BALBOA BLVD STE 300
ENCINO CA
91316-2804
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 818-937-9969
  • Fax:
Mailing address:
  • Phone: 818-550-0900
  • Fax: 505-293-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG47901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG47901
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES K NEAL
Title or Position: PRESIDENT
Credential: MD
Phone: 818-550-0900