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General NPI Number Information
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NPI Number | 1699834168
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Entity Type | Individual
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Provider Name | IDENA DAVIDSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 900 S ATLANTIC BLVD
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4716
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Country | US
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Telephone | 626-570-9000
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Fax | 626-570-5700
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1053
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Fax | 714-647-1245
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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 | RN056988
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License Number State | LA
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