Healthcare Provider Details

I. General information

NPI: 1942227624
Provider Name (Legal Business Name): MAURICE D CYRUS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GREENFIELD AVE
HANFORD CA
93230-3513
US

IV. Provider business mailing address

PO BOX 3109
PINEDALE CA
93650-3109
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9000
  • Fax:
Mailing address:
  • Phone: 559-436-0871
  • Fax: 559-436-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: