Basic Information
| Provider Information | |||||||||
| NPI: | 1922297761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHULA VISTA ANESTHESIA CONSULTANTS MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1809 | ||||||||
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| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928560809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145601580 | ||||||||
| FaxNumber: | 7145601585 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 H ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919104307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196917000 | ||||||||
| FaxNumber: | 6196917443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | DINH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | Q. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7145601580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.