Individual
JUANCHO C. DEPAOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1301 S CRISMON RD, MESA, AZ 85209-3767
(800) 402-0881
Mailing address
21215 E VALLEJO ST, QUEEN CREEK, AZ 85142-5332
(407) 864-0420
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0791
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3038203 00
—
FL
01
—
G2859
BCBS
FL
01
—
G2859P
MEDICARE
FL
Enumeration date
07/16/2006
Last updated
04/25/2024
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