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General NPI Number Information
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NPI Number | 1326240367
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Entity Type | Individual
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Provider Name | MARTIN BENGT JACOBSSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 1700 MOUNT VERNON AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93306-4018
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Country | US
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Telephone | 661-326-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 26792 MADIGAN DR
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-4809
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Country | US
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Telephone | 661-250-0709
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA3023
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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 | 509823
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License Number State | CA
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