Healthcare Provider Details

I. General information

NPI: 1114092632
Provider Name (Legal Business Name): LALEH AMAYA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR SUITE 600
BEVERLY HILLS CA
90210-4232
US

IV. Provider business mailing address

450 N ROXBURY DR SUITE 600
BEVERLY HILLS CA
90210-4232
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-2280
  • Fax: 310-651-2260
Mailing address:
  • Phone: 310-651-2280
  • Fax: 310-651-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number463369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: