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NPI Code Detail

MEDICARE: GARY HAVLICEK CRNA

MEDICARE:   GARY  HAVLICEK  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
1367500000XCertified Registered Nurse Anesthetist74CA

General Provider Information

NPI Number : 1568553436
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY HAVLICEK CRNA
Provider Business Mailing Address
First Line : 3050 E AIRPORT WAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2404
Country : US
Telephone Number : 562-426-9661
Fax Number : 562-426-4227
Provider Business Practice Location Address
First Line : 165 N CLARK ST
Second Line :
City : FRESNO
State : CA
Zip : 93701-2108
Country : US
Telephone Number : 559-233-8657
Fax Number : 559-233-0990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 07/08/2007

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