Individual
BERT MEKPONGSATORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13012 VALLEYHEART DR, 1, STUDIO CITY, CA 91604-1975
(818) 674-0732
Mailing address
13012 VALLEYHEART DR., 1, STUDIO CITY, CA 91604
(818) 674-0732
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4101
CA
390200000X
Student in an Organized Health Care Education/Training Program
710647
CA
Other
Enumeration date
05/10/2011
Last updated
09/28/2011
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