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General NPI Number Information
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NPI Number | 1962826685
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Entity Type | Organization
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Legal Business Name | SEASIDE NURSING ANESTHESIA PC
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 935 GENTER ST UNIT 404
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City | LA JOLLA
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State | CA
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Zip | 92037-5530
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Country | US
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Telephone | 858-337-3179
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Fax |
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Provider Business Mailing Address
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Address Line | 935 GENTER ST UNIT 404
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City | LA JOLLA
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State | CA
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Zip | 92037-5530
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Country | US
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Telephone | 858-337-3179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM ROINESTAD HARBIN
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Credential | CRNA
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Telephone | 858-337-3179
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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 | 4125
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License Number State | CA
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