Healthcare Provider Details

I. General information

NPI: 1033965066
Provider Name (Legal Business Name): MONTEREY BAY ANESTHESIA, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR STE 200
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

416B MAIN ST
SALINAS CA
93901-3306
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax:
Mailing address:
  • Phone: 831-800-7887
  • Fax: 831-998-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LENORA JUSTINE KNUDSON
Title or Position: PRESIDENT/CEO/OWNER
Credential: CRNA
Phone: 208-695-5694