Healthcare Provider Details

I. General information

NPI: 1265923999
Provider Name (Legal Business Name): MICHAEL DAVID CHOLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CALLE CONCEPCION VERA
MOCA PR
00676-5005
US

IV. Provider business mailing address

PO BOX 250620
AGUADILLA PR
00604-0620
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-8000
  • Fax:
Mailing address:
  • Phone: 775-240-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA223032
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9482933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: