Individual
GARY HAVLICEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
165 N CLARK ST, FRESNO, CA 93701-2108
(559) 233-8657
(559) 233-0990
Mailing address
3050 E AIRPORT WAY, LONG BEACH, CA 90806-2404
(562) 426-9661
(562) 426-4227
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
74
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2565630
MEDI-CAL
CA
Enumeration date
09/27/2006
Last updated
07/08/2007
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