1578896023 NPI number — RELIABLE ANESTHESIA MEDICAL GROUP

Table of content: JOHN ROBERT MORGAN II M.D. (NPI 1386608032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578896023 NPI number — RELIABLE ANESTHESIA MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE ANESTHESIA MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1578896023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4666 ADMIRALTY WAY
Provider Second Line Business Mailing Address:
WEST HELIX #9
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-6622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-306-8481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4666 ADMIRALTY WAY
Provider Second Line Business Practice Location Address:
WEST HELIX #9
Provider Business Practice Location Address City Name:
MARINA DEL REY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90292-6622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-306-8481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VERBUKH
Authorized Official First Name:
ISAAC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-306-8481

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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