Provider Demographics
NPI:1104373281
Name:ADVANCED ANESTHESIA MEDICAL GROUP, INC
Entity type:Organization
Organization Name:ADVANCED ANESTHESIA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGUED
Authorized Official - Middle Name:
Authorized Official - Last Name:FADLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-225-0045
Mailing Address - Street 1:7325 MEDICAL CENTER DRIVE
Mailing Address - Street 2:103
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-225-0045
Mailing Address - Fax:
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:#103
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-225-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64236207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093049413OtherNPI
CA1093049413OtherNPI