Provider Demographics
NPI:1255400800
Name:WAKUGAWA, GRACE H (CRNA)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:H
Last Name:WAKUGAWA
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 1:5176 WILLOW WOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2321
Mailing Address - Country:US
Mailing Address - Phone:310-722-7348
Mailing Address - Fax:310-375-6464
Practice Address - Street 1:5176 WILLOW WOOD RD
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2321
Practice Address - Country:US
Practice Address - Phone:310-722-7348
Practice Address - Fax:310-375-6464
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5132200Medicaid
CARN5132200Medicaid