Healthcare Provider Details

I. General information

NPI: 1821422601
Provider Name (Legal Business Name): YASER SALSABIL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 W SCHOOL HOUSE LN APT K806A
PHILADELPHIA PA
19144-5401
US

IV. Provider business mailing address

2979 W SCHOOL HOUSE LN APT K806A
PHILADELPHIA PA
19144-5401
US

V. Phone/Fax

Practice location:
  • Phone: 304-552-4783
  • Fax:
Mailing address:
  • Phone: 304-552-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN623718
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: