Individual
JACQUELINE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3350 W BALL RD, ANESTHESIA DEPARTMENT, ANAHEIM, CA 92804-3710
(714) 827-6700
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 347-1010
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
R148323
MD
367500000X
Certified Registered Nurse Anesthetist
Primary
3393
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000831101
—
MD
Enumeration date
07/07/2005
Last updated
07/15/2010
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