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General NPI Number Information
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NPI Number | 1760142244
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Entity Type | Organization
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Legal Business Name | LIEZLE AREVALO CRNA PROFESSIONAL NURSING ANESTHESIA INC
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 900 E WASHINGTON ST STE 155
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City | COLTON
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State | CA
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Zip | 92324-4196
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Country | US
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Telephone | 909-370-2190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LIEZLE AREVALO
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Credential | CRNA
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Telephone | 310-792-3914
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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 |
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License Number State |
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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 |
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License Number State |
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