Healthcare Provider Details

I. General information

NPI: 1619066651
Provider Name (Legal Business Name): BERENICE RIVERA-CRUZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 FLOWER ST
BAKERSFIELD CA
93305-4144
US

IV. Provider business mailing address

10153 BROMONT AVE
SUN VALLEY CA
91352-1147
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax: 661-326-2000
Mailing address:
  • Phone: 818-602-8398
  • Fax: 818-767-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number512998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: