Provider Demographics
NPI:1013310317
Name:TOMASSIAN, NAZARET (CRNA)
Entity Type:Individual
Prefix:
First Name:NAZARET
Middle Name:
Last Name:TOMASSIAN
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 1:607 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5766
Mailing Address - Country:US
Mailing Address - Phone:951-850-3444
Mailing Address - Fax:
Practice Address - Street 1:607 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5766
Practice Address - Country:US
Practice Address - Phone:951-850-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000314367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered