Healthcare Provider Details

I. General information

NPI: 1285609982
Provider Name (Legal Business Name): PETER A. OKUBO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 NW 107TH TER #200
SUNRISE FL
33322-3418
US

IV. Provider business mailing address

10851 SW 30TH PL
DAVIE FL
33328-1541
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-0636
  • Fax: 954-741-0639
Mailing address:
  • Phone: 954-261-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3042592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: