Healthcare Provider Details

I. General information

NPI: 1316353543
Provider Name (Legal Business Name): ANDREI CALUGARU RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9540 HILLSIDE RD
RANCHO CUCAMONGA CA
91737-1648
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-5000
  • Fax:
Mailing address:
  • Phone: 909-380-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number754643
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: