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General NPI Number Information
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NPI Number | 1083006928
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Entity Type | Organization
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Legal Business Name | ENCINO ANESTHESIA ASSOCIATES INC
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD STE 300
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 818-937-9969
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5486
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City | ORANGE
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State | CA
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Zip | 92863-5486
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Country | US
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Telephone | 818-550-0900
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Fax | 505-293-1524
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES K NEAL
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Credential | MD
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Telephone | 818-550-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G47901
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G47901
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License Number State | CA
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