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General NPI Number Information
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NPI Number | 1376001925
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Entity Type | Individual
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Provider Name | KEVIN LEE SRNA
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Gender | Male
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Dates
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Enumeration Date | 03/03/2019
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Last Update Date | 03/03/2019
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Provider Practice Location Address
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Address Line | 305 N MARTIN AVE
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City | TUCSON
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State | AZ
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Zip | 85721-0001
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Country | US
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Telephone | 520-626-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 8953 W MARCONI AVE
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City | PEORIA
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State | AZ
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Zip | 85382-3731
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Country | US
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Telephone | 253-222-0632
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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 | RN216771
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License Number State | AZ
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