Basic Information
| Provider Information | |||||||||
| NPI: | 1689892705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST-WEST ANESTHESIA MEDICAL GROUP INC | ||||||||
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| OtherOrganizationName: | ALTERNATIVE ANESTHESIA MEDICAL GROUP INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4247 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916170247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189841942 | ||||||||
| FaxNumber: | 8187865417 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913071902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189841942 | ||||||||
| FaxNumber: | 8187865417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 08/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | BOLANDER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8189841942 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EAST WEST ANESTHESIA MEDICAL GROUP INC | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | C22022 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.