Provider Demographics
NPI:1558777029
Name:BOHAN, TIMOTHY DANIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:BOHAN
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 1:30977 STARFIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7999
Mailing Address - Country:US
Mailing Address - Phone:949-933-9555
Mailing Address - Fax:
Practice Address - Street 1:30977 STARFIRE CIR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7999
Practice Address - Country:US
Practice Address - Phone:949-933-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA95000225367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered