Provider Demographics
NPI:1760573406
Name:HARDY, DEBORAH LEATHA (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEATHA
Last Name:HARDY
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 1:19521 CANEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2418
Mailing Address - Country:US
Mailing Address - Phone:310-608-0331
Mailing Address - Fax:310-635-1340
Practice Address - Street 1:19521 CANEY AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2418
Practice Address - Country:US
Practice Address - Phone:310-608-0331
Practice Address - Fax:310-635-1340
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN2337980OtherMEDI-CAL