Provider Demographics
NPI:1669735080
Name:CRITICAL CARE REGISTERED NURSING NURSE ANESTHESIA INC
Entity type:Organization
Organization Name:CRITICAL CARE REGISTERED NURSING NURSE ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:818-518-3537
Mailing Address - Street 1:5826 KELVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5313
Mailing Address - Country:US
Mailing Address - Phone:818-518-3537
Mailing Address - Fax:
Practice Address - Street 1:1111 N CHINA LAKE BLVD
Practice Address - Street 2:220
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-446-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3167251J00000X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No251J00000XAgenciesNursing Care