Basic Information
| Provider Information | |||||||||
| NPI: | 1609175165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENCAL ANESTHESIA AND NURSING INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3109 | ||||||||
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| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936503109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594365221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1395 W LACEY BLVD | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594365221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2011 | ||||||||
| LastUpdateDate: | 03/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | CYRUS | ||||||||
| AuthorizedOfficialFirstName: | MAURICE | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5594360871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.