=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245255041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK E COMUNALE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 10/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N PEPPER AVE DEPARTMENT OF ANESTHESIOLOGY, 2ND FLOOR
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-580-2440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 765 INLAND EMPIRE ANESTHESIA MEDICAL GROUP, INC.
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-0800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-918-3686
-----------------------------------------------------
Fax | 909-580-2440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 2002030173
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------