Healthcare Provider Details

I. General information

NPI: 1619727724
Provider Name (Legal Business Name): CHRISTOPHER VRAA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 W SUNSET BLVD
LOS ANGELES CA
90027-5969
US

IV. Provider business mailing address

4407 PROSPECT AVE APT 3
LOS ANGELES CA
90027-5525
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-8062
  • Fax:
Mailing address:
  • Phone: 951-231-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95249045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: