Basic Information
| Provider Information | |||||||||
| NPI: | 1710285655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ANESTHESIA SERVICES OF NORTHERN CALIFORNIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 COMMERCE DR | ||||||||
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| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146373530 | ||||||||
| FaxNumber: | 9145602227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 N CALIFORNIA ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952046019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099432000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | KOCH | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9146373530 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.