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Organization
PACWEST ANESTHESIA MEDICAL GROUP, INC
Active
Organization
PACWEST ANESTHESIA MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO P GIDAYA JR. MD (PRESIDENT)
(213) 742-5401
Entity
Organization
Contact information
Practice address
1401 S GRAND AVE, LOS ANGELES, CA 90015-3010
(213) 748-2411
Mailing address
PO BOX 60790, PASADENA, CA 91116-6790
(626) 795-9596
(714) 918-0135
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A38770
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103850
—
CA
01
—
ZZZ504667Y
BLUE SHIELD
CA
Enumeration date
04/27/2006
Last updated
05/20/2010
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