Provider Demographics
NPI:1114092632
Name:AMAYA, LALEH (CRNA)
Entity Type:Individual
Prefix:
First Name:LALEH
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4232
Mailing Address - Country:US
Mailing Address - Phone:310-651-2280
Mailing Address - Fax:310-651-2260
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:SUITE 600
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4232
Practice Address - Country:US
Practice Address - Phone:310-651-2280
Practice Address - Fax:310-651-2260
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463369367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA463369OtherSTATE LICENSE NURSING
CA2247OtherNURSE ANESTHETIST
CAP00224383Medicare PIN
CA463369OtherSTATE LICENSE NURSING
CAWNA2247BMedicare PIN