Healthcare Provider Details

I. General information

NPI: 1720039696
Provider Name (Legal Business Name): JOHN A DELLARIPA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

22 CORTE VIDRIOSA
SAN CLEMENTE CA
92673
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-3619
  • Fax:
Mailing address:
  • Phone: 310-947-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: