Provider Demographics
NPI:1932525060
Name:MCLARTY, SUONG N (CRNA)
Entity Type:Individual
Prefix:
First Name:SUONG
Middle Name:N
Last Name:MCLARTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SUONG
Other - Middle Name:NGOC
Other - Last Name:THAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15376 ROCHELLE ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1040
Mailing Address - Country:US
Mailing Address - Phone:909-910-4113
Mailing Address - Fax:
Practice Address - Street 1:15376 ROCHELLE ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1040
Practice Address - Country:US
Practice Address - Phone:909-910-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710376163W00000X
CA92000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse