Healthcare Provider Details

I. General information

NPI: 1366625360
Provider Name (Legal Business Name): GUARDIAN AMBULATORY ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

IV. Provider business mailing address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-2190
  • Fax: 949-588-2199
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG27238
License Number StateCA

VIII. Authorized Official

Name: DEAN MOLLNER
Title or Position: PRESIDENT
Credential: MD
Phone: 949-588-2190