Healthcare Provider Details

I. General information

NPI: 1669801841
Provider Name (Legal Business Name): DHANYA RENJITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DHANYA DHARMARAJ

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 VALLEY VIEW RD APT #123
GLENDALE CA
91202-1751
US

IV. Provider business mailing address

1401 VALLEY VIEW RD APT #123
GLENDALE CA
91202-1751
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-0075
  • Fax: 310-295-0065
Mailing address:
  • Phone: 310-200-0075
  • Fax: 310-295-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: