Provider Demographics
NPI:1366510976
Name:PORTOLA ANESTHESIA SERVICES, LLC
Entity type:Organization
Organization Name:PORTOLA ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-716-2726
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 364
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-716-2726
Mailing Address - Fax:949-716-2892
Practice Address - Street 1:27758 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 364
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6709
Practice Address - Country:US
Practice Address - Phone:949-716-2726
Practice Address - Fax:949-716-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty