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General NPI Number Information
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NPI Number | 1912573981
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Entity Type | Organization
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Legal Business Name | DESCANSO ANESTHESIA GROUP
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 1812 VERDUGO BLVD
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City | GLENDALE
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State | CA
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Zip | 91208-1407
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Country | US
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Telephone | 818-790-7100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60790
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City | PASADENA
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State | CA
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Zip | 91116-6790
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Country | US
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Telephone | 626-795-6596
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY PARKS
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Credential | MD
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Telephone | 626-354-4610
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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 |
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License Number State |
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