Healthcare Provider Details

I. General information

NPI: 1396151338
Provider Name (Legal Business Name): KIMBERLY ANNE MERAZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANNE MIDDLETON

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD STE 100
IRVINE CA
92618-2126
US

IV. Provider business mailing address

23301 RIDGE ROUTE DR SPC 115
LAGUNA HILLS CA
92653-1722
US

V. Phone/Fax

Practice location:
  • Phone: 706-402-5480
  • Fax:
Mailing address:
  • Phone: 706-402-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN201631
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: