Provider Demographics
NPI:1457420168
Name:FOURNIER, DAVID JAMES (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:FOURNIER
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 1:10484 TROON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4438
Mailing Address - Country:US
Mailing Address - Phone:310-837-3712
Mailing Address - Fax:310-837-7240
Practice Address - Street 1:465 N ROXBURY DR STE 802
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-837-3712
Practice Address - Fax:310-837-7240
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
CANA1152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA36836AMedicare ID - Type Unspecified