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General NPI Number Information
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NPI Number | 1154569523
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST ANESTHESIA LLC
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 4790 IRVINE BLVD STE 105-355
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City | IRVINE
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State | CA
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Zip | 92620-1973
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Provider Business Mailing Address
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Address Line | 4790 IRVINE BLVD STE 105-355
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City | IRVINE
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State | CA
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Zip | 92620-1973
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | ED STANLEY
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Credential | CRNA
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 27940
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License Number State | CA
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