Basic Information
| Provider Information | |||||||||
| NPI: | 1821427196 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW LINE ANESTHESIA SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 80182 | ||||||||
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| City: | CITY OF INDUSTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917168178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106985477 | ||||||||
| FaxNumber: | 3103794856 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907323505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108323311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2013 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | IRV | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3103792134 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A66108 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.