Healthcare Provider Details

I. General information

NPI: 1447681309
Provider Name (Legal Business Name): OCM ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 TALBERT AVE
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-7000
  • Fax: 714-647-1245
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA47949
License Number StateCA

VIII. Authorized Official

Name: DR. MAGDI A SIDHOM
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 714-347-1000