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Physician Assistants & Advanced Practice Nursing Providers Nurse Anesthetist, Certified Registered

Provider NPI: 1174607543

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 323-442-7400  Fax: 323-442-7411

Business Mailing Address:
1520 SAN PABLO ST SUITE 3451 LOS ANGELES, CA 90033-5310 US
Tel: 323-442-7400  Fax: 323-442-7411

NPI Information:
NPI: 1174607543
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 367500000X





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