Healthcare Provider Details

I. General information

NPI: 1922468784
Provider Name (Legal Business Name): CHRISTOPHER JULES CIAMAICHELO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR STE 106
GLENDALE CA
91205-4437
US

IV. Provider business mailing address

PO BOX 25033
SANTA ANA CA
92799-5033
US

V. Phone/Fax

Practice location:
  • Phone: 310-897-8429
  • Fax:
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-795-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: