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Organization
PROVIDENT ANESTHESIA MEDICAL GROUP INC
Active
Organization
PROVIDENT ANESTHESIA MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. A JOSEPH HERBERT M.D. (PRESIDENT)
(818) 550-0900
Entity
Organization
Contact information
Practice address
7300 MEDICAL CTR, WEST HILLS, CA 91307-1902
(818) 550-0900
(505) 293-1524
Mailing address
PO BOX 5486, ORANGE, CA 92863-5486
(818) 550-0900
(505) 293-1524
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G46241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0083620
—
CA
01
—
ZZZ56463Z
BLUE SHIELD
CA
Enumeration date
02/12/2007
Last updated
03/27/2024
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