Healthcare Provider Details

I. General information

NPI: 1336318070
Provider Name (Legal Business Name): KARNADI PETER DOEVE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER DOEVE CRNA

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DOHENY CIR
CORONA CA
92881-8459
US

IV. Provider business mailing address

530 DOHENY CIR
CORONA CA
92881-8459
US

V. Phone/Fax

Practice location:
  • Phone: 951-283-5509
  • Fax:
Mailing address:
  • Phone: 951-283-5509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: