Basic Information
| Provider Information | |||||||||
| NPI: | 1861893166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORE ANESTHESIA ASSOCIATES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 HUNTINGTON DR | ||||||||
| Address2: | SUITE 337 | ||||||||
| City: | SAN MARINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911082640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267956596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 W BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTEBELLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906404308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237254209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2014 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | ENG | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6262815998 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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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.