Provider Demographics
NPI:1225061666
Name:CORNEJO, DEBORAH (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CORNEJO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6254 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2148
Mailing Address - Country:US
Mailing Address - Phone:619-795-7949
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACRNA2820367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNA2820AMedicare ID - Type Unspecified
CAP95954Medicare UPIN