Healthcare Provider Details

I. General information

NPI: 1730113259
Provider Name (Legal Business Name): DAVID BUZZACCO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 CALIFORNIA AVE
BOARDMAN OH
44512-5623
US

IV. Provider business mailing address

PO BOX 14806
COLUMBUS OH
43214-0806
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-1954
  • Fax:
Mailing address:
  • Phone: 614-261-3724
  • Fax: 614-447-9593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN229076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: