Provider Demographics
NPI:1063480275
Name:FLATEN, ERIC L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:L
Last Name:FLATEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-446-3551
Mailing Address - Fax:760-499-3014
Practice Address - Street 1:1081 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3130
Practice Address - Country:US
Practice Address - Phone:760-446-3551
Practice Address - Fax:760-499-3014
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN568591367500000X
CACRNA2646367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5685910Medicaid
CANA2646OtherBS OF CA
CA430060085OtherRAILROAD MEDICARE
CA430060085OtherRAILROAD MEDICARE
CAZZZ18566ZMedicare ID - Type Unspecified
S72138Medicare UPIN