Healthcare Provider Details

I. General information

NPI: 1831843564
Provider Name (Legal Business Name): ANGELICA LLAMAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MALL DR
HANFORD CA
93230-5786
US

IV. Provider business mailing address

115 MALL DR
HANFORD CA
93230-5786
US

V. Phone/Fax

Practice location:
  • Phone: 661-633-2300
  • Fax:
Mailing address:
  • Phone: 661-633-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number846844
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95001722
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: