Healthcare Provider Details

I. General information

NPI: 1205073384
Provider Name (Legal Business Name): MICHAEL P O'HARA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GREENFIELD AVE
HANFORD CA
93230-3513
US

IV. Provider business mailing address

2635 G ST
BAKERSFIELD CA
93301-2813
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9000
  • Fax:
Mailing address:
  • Phone: 661-633-1500
  • Fax: 661-633-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA3735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: