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NPI Code Detail

MEDICARE: CRESTA VENTOSA INC

MEDICARE: CRESTA VENTOSA INC
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 Anesthetist2712CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12712OTHERCACRNA LICENSE
2488921OTHERCARN LICENSE

General Provider Information

NPI Number : 1619101433
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTA VENTOSA INC
Provider Business Mailing Address
First Line : PO BOX 34120
Second Line :
City : RENO
State : NV
Zip : 89533-4120
Country : US
Telephone Number : 775-747-5050
Fax Number :
Provider Business Practice Location Address
First Line : 11216 TRINITY RIVER DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-2968
Country : US
Telephone Number : 916-635-6161
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SCOTT STEPHEN MINNICK
Credential : CRNA
Telephone Number : 209-245-5559
Provider Enumeration Date : 05/07/2009
Last Update Date : 05/07/2009

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