Healthcare Provider Details

I. General information

NPI: 1578676524
Provider Name (Legal Business Name): M.D. ANESTHESIA CONSULTANTS, AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 KEARNY VILLA RD STE 100
SAN DIEGO CA
92123-1960
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 858-268-3566
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG81418
License Number StateCA

VIII. Authorized Official

Name: DR. CRYSTAL D KATZ
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 800-883-7243