Healthcare Provider Details

I. General information

NPI: 1952809865
Provider Name (Legal Business Name): CORNERSTONE SURGERY CENTER & ANESTHESIA NURSING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10694 MAGNOLIA AVE
RIVERSIDE CA
92505-1816
US

IV. Provider business mailing address

10694 MAGNOLIA AVE
RIVERSIDE CA
92505-1816
US

V. Phone/Fax

Practice location:
  • Phone: 951-977-9778
  • Fax: 951-977-9768
Mailing address:
  • Phone: 951-335-5250
  • Fax: 951-335-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WAYLAN WYATT KRUSE
Title or Position: CHIEF/OFFICER
Credential: CRNA, MSN
Phone: 951-335-5250