Healthcare Provider Details

I. General information

NPI: 1366626673
Provider Name (Legal Business Name): JANEEN ROSE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

33476 SOMERSET RD
YUCAIPA CA
92399-3440
US

V. Phone/Fax

Practice location:
  • Phone: 909-528-1000
  • Fax:
Mailing address:
  • Phone: 909-790-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: