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General NPI Number Information
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NPI Number | 1144551730
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Entity Type | Individual
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Provider Name | VADIM SMIRNOV CRNA, MSN, MD
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Gender | Male
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | RAYMOND RENAISSANCE SURGERY CENTER 125 N RAYMOND AV 212
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City | PASADENA
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State | CA
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Zip | 91103
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Country | US
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Telephone | 415-290-0489
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Fax |
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Provider Business Mailing Address
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Address Line | 722 S MANHATTAN PL APT 301
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City | LOS ANGELES
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State | CA
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Zip | 90005-3122
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Country | US
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Telephone | 415-290-0489
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3879
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License Number State | CA
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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 | 3879
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License Number State | CA
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