Provider Demographics
NPI:1376636183
Name:OLEARY, DENNIS R (CRNA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:OLEARY
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:PO BOX 7202 RANCH STATION
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-7202
Mailing Address - Country:US
Mailing Address - Phone:818-727-5908
Mailing Address - Fax:
Practice Address - Street 1:433 NORTH CAMDEN DR SUITE 1170
Practice Address - Street 2:OFFICE SURGICAL SUITE OF PETER GIAWBAZZI MD
Practice Address - City:BEVERERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:818-727-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA34581Medicare ID - Type Unspecified