Healthcare Provider Details

I. General information

NPI: 1366537128
Provider Name (Legal Business Name): TIMOTHY J. LUNN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W CHAPMAN AVE SUITE 200
ORANGE CA
92868-2304
US

IV. Provider business mailing address

3050 E AIRPORT WAY
LONG BEACH CA
90806-2404
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-9661
  • Fax: 562-426-4227
Mailing address:
  • Phone: 562-426-9661
  • Fax: 562-426-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: