Healthcare Provider Details

I. General information

NPI: 1568528784
Provider Name (Legal Business Name): TOMASZ WOJCZYK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

295 HUBBARD GULCH RD
BEN LOMOND CA
95005-9221
US

V. Phone/Fax

Practice location:
  • Phone: 408-820-1293
  • Fax:
Mailing address:
  • Phone: 408-564-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: