Healthcare Provider Details

I. General information

NPI: 1710030200
Provider Name (Legal Business Name): CHRIS S STEIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 RESEDA BLVD
NORTHRIDGE CA
91324
US

IV. Provider business mailing address

8331 RESEDA BLVD
NORTHRIDGE CA
91324
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-3428
  • Fax:
Mailing address:
  • Phone: 818-993-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA2112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: