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General NPI Number Information
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NPI Number | 1386177186
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS ANESTHESIA, INC.
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 1980 N ORANGE GROVE AVE
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City | POMONA
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State | CA
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Zip | 91767-3008
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Country | US
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Telephone | 909-766-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 9461 CHARLEVILLE BLVD #476
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3017
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Country | US
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Telephone | 818-219-2442
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JAMIE L HIDALGO
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Credential |
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Telephone | 818-219-2442
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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 | G88694
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License Number State | CA
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