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General NPI Number Information
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NPI Number | 1073843041
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Entity Type | Individual
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Provider Name | CHRISTOPHER E KOETTEL CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 850 S ATLANTIC BLVD STE 201
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6705
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Country | US
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Telephone | 626-872-0264
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 14-109710-092
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 556943
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 140281
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3853
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License Number State | CA
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