Basic Information
| Provider Information | |||||||||
| NPI: | 1669735080 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRITICAL CARE REGISTERED NURSING NURSE ANESTHESIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5826 KELVIN AVE | ||||||||
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| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913675313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185183537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 N CHINA LAKE BLVD | ||||||||
| Address2: | 220 | ||||||||
| City: | RIDGECREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935553131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604468100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | ANGELES | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 8185183537 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | 3167 | CA | N | Agencies | Nursing Care | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.