Healthcare Provider Details

I. General information

NPI: 1205698115
Provider Name (Legal Business Name): PALMDALE ANESTHESIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

898 N PACIFIC COAST HWY STE 600
EL SEGUNDO CA
90245-2747
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-5000
  • Fax:
Mailing address:
  • Phone: 310-698-5452
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: IRV EDWARDS
Title or Position: CEO
Credential: MD
Phone: 310-321-0143