MEDICARE: RANA CODREAN CST,CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	161595	AZ

General Provider Information

NPI Number	:	1073976775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANA CODREAN CST,CSFA

Provider Business Mailing Address
First Line	:	20435 N 7TH ST
Second Line	:	APT 1036
City	:	PHOENIX
State	:	AZ
Zip	:	85024-6024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20435 N 7TH ST
Second Line	:	APT 1036
City	:	PHOENIX
State	:	AZ
Zip	:	85024-6024
Country	:	US
Telephone Number	:	714-943-9333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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