Basic Information
| Provider Information | |||||||||
| NPI: | 1083083653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLISON STAVARIDIS CRNA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5486 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928635486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185500900 | ||||||||
| FaxNumber: | 3039538260 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 S ATLANTIC BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917544730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262892894 | ||||||||
| FaxNumber: | 6262892840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2015 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | STAVARIDIS | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 3103677863 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 3574 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.