Healthcare Provider Details

I. General information

NPI: 1962542787
Provider Name (Legal Business Name): JASEN PAUL CHRISTENSEN SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

8 BANSTEAD
DOVE CANYON CA
92679-3739
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 949-713-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number534945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: