Provider Demographics
NPI:1649473703
Name:VENET, GARY P (CRNA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:VENET
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 1:8581 SANTA MONICA BLVD
Mailing Address - Street 2:#413
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:323-871-4191
Mailing Address - Fax:
Practice Address - Street 1:8581 SANTA MONICA BLVD
Practice Address - Street 2:#413
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:323-871-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1243367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered