Organization
FOLSOM ANESTHESIA MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GLENESK M.D. (PRESIDENT)
(916) 983-7490
Entity
Organization
Contact information
Practice address
1650 CREEKSIDE DR, FOLSOM, CA 95630-3400
(916) 983-7461
(916) 983-7569
Mailing address
500 S MAIN ST, 1210, ORANGE, CA 92868-4507
(714) 560-1580
(714) 560-1585
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR005417
—
CA
01
—
ZZZ21587Z
BLUE SHIELD
CA
Enumeration date
07/29/2006
Last updated
07/18/2008
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