Healthcare Provider Details

I. General information

NPI: 1396354510
Provider Name (Legal Business Name): CHRISTIAN PANALIGAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTIAN PAUL CORDA PANALIGAN CRNA

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 09/01/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

4652 N HOLT AVE
FRESNO CA
93705-0824
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-2000
  • Fax:
Mailing address:
  • Phone: 408-771-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: