Healthcare Provider Details

I. General information

NPI: 1750602306
Provider Name (Legal Business Name): ELROSE ANESTHESIA SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N BRAND BLVD STE 200
GLENDALE CA
91202
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-9999
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG79386
License Number StateCA

VIII. Authorized Official

Name: WILLIAM F FRANCIS FORAN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 310-792-3914