Provider Demographics
NPI:1588745871
Name:IRVINE ANESTHESIA CONSULTANTS MEDICAL GROUP
Entity type:Organization
Organization Name:IRVINE ANESTHESIA CONSULTANTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUEHLHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-753-6070
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-753-6070
Mailing Address - Fax:949-753-6055
Practice Address - Street 1:16200 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3714
Practice Address - Country:US
Practice Address - Phone:949-753-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11768Medicare ID - Type Unspecified