Healthcare Provider Details

I. General information

NPI: 1801012489
Provider Name (Legal Business Name): DEBORAH HORAK CRNA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR 200
BEVERLY HILLS CA
90210-4322
US

IV. Provider business mailing address

PO BOX 1597
BEVERLY HILLS CA
90213-1597
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-5752
  • Fax: 909-694-2370
Mailing address:
  • Phone: 909-946-5752
  • Fax: 909-694-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA1830
License Number StateCA

VIII. Authorized Official

Name: DEBORAH A HORAK
Title or Position: PRESIDENT
Credential: CRNA
Phone: 310-246-9004