Healthcare Provider Details

I. General information

NPI: 1992088298
Provider Name (Legal Business Name): ADAM JEREMIAH KUZMIAK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 E BELL RD
PHOENIX AZ
85032-2112
US

IV. Provider business mailing address

PO BOX 41340
PHOENIX AZ
85080-1340
US

V. Phone/Fax

Practice location:
  • Phone: 623-320-0660
  • Fax: 623-320-0670
Mailing address:
  • Phone: 623-320-0660
  • Fax: 623-320-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberCRNA0794
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0794
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN127736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: