Healthcare Provider Details

I. General information

NPI: 1790277135
Provider Name (Legal Business Name): AXIOM ANESTHESIA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST
LOS ANGELES CA
90057
US

IV. Provider business mailing address

PO BOX 8312
PASADENA CA
91109-8312
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-5541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. DWAYNE COX
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 323-717-9436