Healthcare Provider Details

I. General information

NPI: 1740477462
Provider Name (Legal Business Name): FLORCENA MAYO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 TREAT BLVD APT 125
WALNUT CREEK CA
94597-8858
US

IV. Provider business mailing address

1447 TREAT BLVD APT 125
WALNUT CREEK CA
94597-8858
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-0496
  • Fax:
Mailing address:
  • Phone: 323-244-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number079377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: