MEDICARE: JEANNETTE AUSTIN 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	420067	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1710923404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE AUSTIN CRNA

Provider Business Mailing Address
First Line	:	2101 S BEVERLY GLEN BLVD PH 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6076
Country	:	US
Telephone Number	:	970-618-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 CADILLAC AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1702
Country	:	US
Telephone Number	:	323-857-2345
Fax Number	:

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/17/2013

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