Healthcare Provider Details

I. General information

NPI: 1114182557
Provider Name (Legal Business Name): WILLIAM C MADING, MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 200
IRVINE CA
92618-2127
US

IV. Provider business mailing address

PO BOX 969096
SAN DIEGO CA
92196-9096
US

V. Phone/Fax

Practice location:
  • Phone: 949-341-3499
  • 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 NumberG63263A
License Number StateCA

VIII. Authorized Official

Name: WILLIAM C MADING
Title or Position: PRESIDENT
Credential: MD
Phone: 858-495-0971