Healthcare Provider Details

I. General information

NPI: 1942314141
Provider Name (Legal Business Name): KENNETH RAY ELANDT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

651 HUDSPETH ST
SIMI VALLEY CA
93065-5503
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-5039
  • Fax: 805-527-5039
Mailing address:
  • Phone: 805-527-5039
  • Fax: 805-527-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: