Healthcare Provider Details

I. General information

NPI: 1770554016
Provider Name (Legal Business Name): VINOD C BHAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 SYLVA LN SUITE G
SONORA CA
95370-5969
US

IV. Provider business mailing address

940 SYLVA LANE STE G
SONORA CA
95370-5969
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-0340
  • Fax: 209-532-6405
Mailing address:
  • Phone: 209-532-0340
  • Fax: 209-532-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN651476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: