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General NPI Number Information
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NPI Number | 1437499266
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Entity Type | Organization
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Legal Business Name | RAELLE ANESTHESIA INC
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 10694 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1816
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Country | US
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Telephone | 951-335-5264
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Fax | 951-335-5471
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Provider Business Mailing Address
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Address Line | 10694 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-1816
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Country | US
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Telephone | 951-335-5264
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Fax | 951-335-5471
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Authorized Official
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Title or Position | CEO
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Name | WAYLAN WYATT KRUSE
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Credential | CRNA
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Telephone | 951-335-5461
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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 | 4114
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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 | 3956
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License Number State | CA
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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 | 3970
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License Number State | CA
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