Healthcare Provider Details

I. General information

NPI: 1811340920
Provider Name (Legal Business Name): DHG MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINDFLOWER
LAKE FOREST CA
92630-8371
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 949-702-2142
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA114614
License Number StateCA

VIII. Authorized Official

Name: DAVID GUTIERREZ
Title or Position: PRESIDENT
Credential:
Phone: 949-702-2142