Basic Information
| Provider Information | |||||||||
| NPI: | 1760744221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRNALA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 S GRAND AVE APT 906 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900173847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263473410 | ||||||||
| FaxNumber: | 8666403006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S CENTRAL AVE STE 126 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912042571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182474894 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6263473410 | ||||||||
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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 | 367500000X | NA 3307 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.