Healthcare Provider Details

I. General information

NPI: 1215208152
Provider Name (Legal Business Name): JASON ROJAS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POLE LINE RD W
TWIN FALLS ID
83301-5810
US

IV. Provider business mailing address

1465 GRACE DR E
TWIN FALLS ID
83301-3297
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number23791
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: