Provider Demographics
NPI:1932875226
Name:HOO, DERRICK (CRNA)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:HOO
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 1:12 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1704
Mailing Address - Country:US
Mailing Address - Phone:650-553-0077
Mailing Address - Fax:
Practice Address - Street 1:1217 UTOPIA PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4426
Practice Address - Country:US
Practice Address - Phone:650-307-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95143684163W00000X
CA95002281367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse