Healthcare Provider Details

I. General information

NPI: 1336149350
Provider Name (Legal Business Name): JOHN JOSEPH ZAROLA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 ROOSEVELT AVE
GRANTS NM
87020
US

IV. Provider business mailing address

POB 1231
ESPANOLA NM
87532-1231
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-4446
  • Fax:
Mailing address:
  • Phone: 505-929-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR12482
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: