Basic Information
| Provider Information | |||||||||
| NPI: | 1982111456 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MATEO GENNETTE CRNA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2029 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933032029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613357755 | ||||||||
| FaxNumber: | 6613357766 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 OLIVE DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933084137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613994461 | ||||||||
| FaxNumber: | 6613997312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2018 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | REED | ||||||||
| AuthorizedOfficialFirstName: | SANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6613357755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 95000160 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.