Healthcare Provider Details

I. General information

NPI: 1043832512
Provider Name (Legal Business Name): LEE-ANA GUZMAN HARDY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 12/30/2021
Certification Date: 08/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4111
  • Fax:
Mailing address:
  • Phone: 831-755-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: