Healthcare Provider Details

I. General information

NPI: 1083989909
Provider Name (Legal Business Name): MADING ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY STE 101
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

PO BOX 969096
SAN DIEGO CA
92196-9096
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-1340
  • Fax:
Mailing address:
  • Phone: 858-495-0971
  • Fax: 858-495-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG063263
License Number StateCA

VIII. Authorized Official

Name: WILLIAM CHARLES MADING
Title or Position: PRESIDENT
Credential:
Phone: 949-212-3194