MEDICARE: MRS. GRACE H. WAKUGAWA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	513220	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255400800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE H. WAKUGAWA CRNA

Provider Business Mailing Address
First Line	:	5176 WILLOW WOOD RD
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-2321
Country	:	US
Telephone Number	:	310-722-7348
Fax Number	:	310-375-6464

Provider Business Practice Location Address
First Line	:	5176 WILLOW WOOD RD
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-2321
Country	:	US
Telephone Number	:	310-722-7348
Fax Number	:	310-375-6464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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