Healthcare Provider Details

I. General information

NPI: 1306139910
Provider Name (Legal Business Name): ANESTHESIA ASSISTED MEDICAL OPIATE DETOXIFICATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 PACIFIC AVE
LONG BEACH CA
90806-2613
US

IV. Provider business mailing address

250 N ROBERTSON BLVD SUITE 419
BEVERLY HILLS CA
90211-1788
US

V. Phone/Fax

Practice location:
  • Phone: 310-205-0808
  • Fax:
Mailing address:
  • Phone: 310-205-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number32166
License Number StateCA

VIII. Authorized Official

Name: CLARE WAISMANN
Title or Position: MANAGER
Credential:
Phone: 310-205-0808