MEDICARE: MR. DELBERT DEAN CRITEL 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	3149	CA

General Provider Information

NPI Number	:	1932281813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DELBERT DEAN CRITEL CRNA

Provider Business Mailing Address
First Line	:	PO BOX 1649
Second Line	:
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315-1649
Country	:	US
Telephone Number	:	909-866-6501
Fax Number	:	909-878-8284

Provider Business Practice Location Address
First Line	:	41870 GARSTIN DRIVE
Second Line	:	BOX 1649
City	:	BIG BEAR LAKE
State	:	CA
Zip	:	92315-1649
Country	:	US
Telephone Number	:	909-866-6501
Fax Number	:	909-878-8284

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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