Provider Demographics
NPI:1538424908
Name:SAN GABRIEL ANESTHESIA ASSOCIATES, PC
Entity type:Organization
Organization Name:SAN GABRIEL ANESTHESIA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-898-2020
Mailing Address - Street 1:288 N SANTA ANITA AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3183
Mailing Address - Country:US
Mailing Address - Phone:800-898-2020
Mailing Address - Fax:844-897-3788
Practice Address - Street 1:1403 N TUSTIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8691
Practice Address - Country:US
Practice Address - Phone:714-633-1338
Practice Address - Fax:844-897-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA455552163Medicaid