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NPI Code Detail

MEDICARE: JACQUELINE STARK CRNA

MEDICARE: JACQUELINE STARK CRNA
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
1174400000XSpecialistR148323MD
2367500000XCertified Registered Nurse Anesthetist3393CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396742284
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE STARK CRNA
Provider Business Mailing Address
First Line : 210 N TUSTIN AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3807
Country : US
Telephone Number : 714-347-1010
Fax Number : 714-647-1245
Provider Business Practice Location Address
First Line : 3350 W BALL RD
Second Line : ANESTHESIA DEPARTMENT
City : ANAHEIM
State : CA
Zip : 92804-3710
Country : US
Telephone Number : 714-827-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/15/2010

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Directions to “ JACQUELINE STARK CRNA” Practice Location

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