MEDICARE: MEREDITH BORG 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	390200000X	Student in an Organized Health Care Education/Training Program	772606	CA
2	367500000X	Certified Registered Nurse Anesthetist	4278	CA

General Provider Information

NPI Number	:	1801144738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH BORG CRNA

Provider Business Mailing Address
First Line	:	2605 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1205
Country	:	US
Telephone Number	:	770-846-4142
Fax Number	:

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	11/29/2021

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