Healthcare Provider Details

I. General information

NPI: 1275929838
Provider Name (Legal Business Name): ANDY BAUM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 IRON POINT RD APT 2423
FOLSOM CA
95630-7820
US

IV. Provider business mailing address

1550 IRON POINT RD APT 2423
FOLSOM CA
95630-7820
US

V. Phone/Fax

Practice location:
  • Phone: 713-204-8565
  • Fax:
Mailing address:
  • Phone: 713-204-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number815196
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP129075
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: