Healthcare Provider Details

I. General information

NPI: 1285939397
Provider Name (Legal Business Name): VAPORWORKS NURSING ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NORUMBEGA DR
MONROVIA CA
91016-2415
US

IV. Provider business mailing address

241 NORUMBEGA DR
MONROVIA CA
91016-2415
US

V. Phone/Fax

Practice location:
  • Phone: 626-423-4368
  • Fax:
Mailing address:
  • Phone: 626-423-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA#3705
License Number StateCA

VIII. Authorized Official

Name: JULIA HARRIS
Title or Position: PRESIDENT
Credential: CRNA
Phone: 626-423-4368