Healthcare Provider Details

I. General information

NPI: 1053354233
Provider Name (Legal Business Name): ANESTHESIA SERVICE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 RUFFIN RD
SAN DIEGO CA
92123-1810
US

IV. Provider business mailing address

3626 RUFFIN RD
SAN DIEGO CA
92123-1810
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-9666
  • Fax: 858-565-9441
Mailing address:
  • Phone: 858-565-9666
  • Fax: 858-565-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YOLANDA MARZAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-565-9666