Healthcare Provider Details

I. General information

NPI: 1548635428
Provider Name (Legal Business Name): UMA BHASKARA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 PONTIAC STREET
LA CRESCENTA CA
91214
US

IV. Provider business mailing address

3206 PONTIAC STREET
LA CRESCENTA CA
91214
US

V. Phone/Fax

Practice location:
  • Phone: 818-957-5718
  • Fax:
Mailing address:
  • Phone: 818-957-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number108504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: