Provider Demographics
NPI:1184652653
Name:MATHEIS, BILL M (CRNA)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:M
Last Name:MATHEIS
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 1:795 PLAYA BLANCA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7717
Mailing Address - Country:US
Mailing Address - Phone:951-295-5707
Mailing Address - Fax:951-279-5878
Practice Address - Street 1:795 PLAYA BLANCA CIRCLE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:93879
Practice Address - Country:US
Practice Address - Phone:951-295-5707
Practice Address - Fax:951-279-5878
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA 3057367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW973XMedicare PIN
CAAO573YMedicare PIN