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General NPI Number Information
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NPI Number | 1558925610
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ANESTHESIA CONSULTANTS OF CALIFORNIA
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 5176 HILL RD E
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City | LAKEPORT
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State | CA
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Zip | 95453-6300
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Country | US
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Telephone | 707-262-5000
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Fax | 916-736-5499
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Provider Business Mailing Address
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Address Line | PO BOX 25033
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City | SANTA ANA
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State | CA
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Zip | 92799-5033
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Country | US
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Telephone | 714-347-1000
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Fax | 714-795-6829
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KERRY J HOLLENBECK
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Credential | MD
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Telephone | 714-347-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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