Healthcare Provider Details

I. General information

NPI: 1083148142
Provider Name (Legal Business Name): VAMM NURSING ANESTHETISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 04/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HOLLAND SUITE 101
IRVINE CA
92618-2566
US

IV. Provider business mailing address

5 HOLLAND SUITE 101
IRVINE CA
92618-2566
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-2190
  • Fax: 949-588-2199
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTORIA A. MAHONY
Title or Position: PRESIDENT/OWNER
Credential: CRNA
Phone: 805-786-4878