MEDICARE: JASON M APPLEGATE 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
1	367500000X	Certified Registered Nurse Anesthetist	NA4329	CA

General Provider Information

NPI Number	:	1477608040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M APPLEGATE CRNA

Provider Business Mailing Address
First Line	:	8440 FOUNTAIN AVE APT 302
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2567
Country	:	US
Telephone Number	:	424-666-9752
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 N ROXBURY DR STE 600
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4225
Country	:	US
Telephone Number	:	310-651-2050
Fax Number	:	310-651-2055

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	09/10/2022

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