Healthcare Provider Details

I. General information

NPI: 1326009994
Provider Name (Legal Business Name): RANDY EUGENE ASHMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

2854 W CANYON AVE
SAN DIEGO CA
92123-4648
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 619-301-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: