Healthcare Provider Details

I. General information

NPI: 1003010182
Provider Name (Legal Business Name): ROBERT CRAIG ANDERSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

PO BOX 31001-1838
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN467243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: