Healthcare Provider Details

I. General information

NPI: 1770299216
Provider Name (Legal Business Name): CHRISTINA ST CLAIR TAYLOR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA ST. CLAIR DIBARTOLOMEO RN

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

17634 ELM RD N
MAPLE GROVE MN
55311-3826
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4475
  • Fax:
Mailing address:
  • Phone: 612-385-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: