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General NPI Number Information
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NPI Number | 1942314141
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Entity Type | Individual
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Provider Name | KENNETH RAY ELANDT CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 436 N BEDFORD DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4310
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Country | US
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Telephone | 805-527-5039
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Fax | 805-527-5039
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Provider Business Mailing Address
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Address Line | 651 HUDSPETH ST
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City | SIMI VALLEY
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State | CA
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Zip | 93065-5503
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Country | US
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Telephone | 805-527-5039
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Fax | 805-527-5039
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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 | NA439
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License Number State | CA
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