Basic Information
| Provider Information | |||||||||
| NPI: | 1104023365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAFE ANESTHESIA MEDICAL GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WEST LOS ANGELES ANESTHESIA MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 269 S BEVERLY DR # 511 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902123807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232900725 | ||||||||
| FaxNumber: | 3232900727 | ||||||||
| Practice Location | |||||||||
| Address1: | 2231 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232900725 | ||||||||
| FaxNumber: | 3232900727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | BROWNELL | ||||||||
| AuthorizedOfficialMiddleName: | HILLARD | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3232900725 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A26350 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.