Provider Demographics
NPI:1336605682
Name:BESERRA, JON DAVID II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:DAVID
Last Name:BESERRA
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:DAVID
Other - Last Name:BESERRA
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:8073 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3842
Mailing Address - Country:US
Mailing Address - Phone:702-469-1946
Mailing Address - Fax:
Practice Address - Street 1:25825 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-325-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered