Provider Demographics
NPI:1861463572
Name:TAUSSIG, SALLY B (CRNA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:B
Last Name:TAUSSIG
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 1:6545 PETIT AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5626
Mailing Address - Country:US
Mailing Address - Phone:818-785-7371
Mailing Address - Fax:
Practice Address - Street 1:14624 SHERMAN WAY
Practice Address - Street 2:#303
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-785-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA838367500000X
CA838367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW269AMedicare PIN
CAR35748Medicare UPIN