Healthcare Provider Details

I. General information

NPI: 1750114328
Provider Name (Legal Business Name): JERRY HONG NGUYEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9479 N FORT WASHINGTON RD STE 103
FRESNO CA
93730-5939
US

IV. Provider business mailing address

7952 CARLYLE DR
RIVERSIDE CA
92509-6131
US

V. Phone/Fax

Practice location:
  • Phone: 559-289-4574
  • Fax:
Mailing address:
  • Phone: 951-756-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: