Basic Information
| Provider Information | |||||||||
| NPI: | 1114182557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM C MADING, MD A MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 969096 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921969096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584950971 | ||||||||
| FaxNumber: | 8584950991 | ||||||||
| Practice Location | |||||||||
| Address1: | 15825 LAGUNA CANYON RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493413499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2008 | ||||||||
| LastUpdateDate: | 07/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | MADING | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8584950971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G63263A | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | G63263A | 01 | CA | MEDICAL LICENSE | OTHER |