Healthcare Provider Details

I. General information

NPI: 1912333980
Provider Name (Legal Business Name): RICK FOX CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2013
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date: 08/04/2022
Reactivation Date: 08/08/2022

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

1927 TARTAN RD
TURLOCK CA
95382-9243
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6000
  • Fax:
Mailing address:
  • Phone: 209-518-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5897742-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: