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General NPI Number Information
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NPI Number | 1558588871
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ANESTHESIA ASSOCIATES MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 559-353-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 6235 N FRESNO ST SUITE #103
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City | FRESNO
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State | CA
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Zip | 93710-5269
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Country | US
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Telephone | 559-449-4350
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Fax | 559-449-4358
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Authorized Official
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Title or Position | TREASURER
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Name | RANDAL MORTON
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Credential | MD
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Telephone | 559-449-4350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | CA
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