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Organization
PENINSULA ANESTHESIA GROUP, INC.
Active
Organization
PENINSULA ANESTHESIA GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE L. GROSS M.D. (PRESIDENT)
(310) 406-3760
Entity
Organization
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
Mailing address
PO BOX 4331, INGLEWOOD, CA 90309-4331
(310) 406-3760
(310) 303-7944
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64632Z
BLUE SHIELD
CA
Enumeration date
04/24/2006
Last updated
04/30/2008
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