Healthcare Provider Details

I. General information

NPI: 1265455661
Provider Name (Legal Business Name): GLENDALE ANESTHESIA CONSULTANTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2508
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-2252
  • Fax: 818-502-2317
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID THEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-795-6596