Healthcare Provider Details

I. General information

NPI: 1457420168
Provider Name (Legal Business Name): DAVID JAMES FOURNIER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 802
BEVERLY HILLS CA
90210-4211
US

IV. Provider business mailing address

10484 TROON AVE
LOS ANGELES CA
90064-4438
US

V. Phone/Fax

Practice location:
  • Phone: 310-837-3712
  • Fax: 310-837-7240
Mailing address:
  • Phone: 310-837-3712
  • Fax: 310-837-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA1152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: