Provider Demographics
NPI:1205257789
Name:COASTAL NURSE ANESTHESIA, INC.
Entity type:Organization
Organization Name:COASTAL NURSE ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CRNA
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-547-5193
Mailing Address - Street 1:3701 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2733
Mailing Address - Country:US
Mailing Address - Phone:562-547-5193
Mailing Address - Fax:
Practice Address - Street 1:3701 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2733
Practice Address - Country:US
Practice Address - Phone:562-547-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2162367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty