Provider Demographics
NPI:1013264951
Name:SHIVE, SARA RONDINONE (RN, BSN, CRNA, MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RONDINONE
Last Name:SHIVE
Suffix:
Gender:F
Credentials:RN, BSN, CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:323-442-7411
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:323-442-7411
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA4295367500000X
CA773040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse