Organization
CRESTA VENTOSA INC
Active
Other names
Minnick Medical Management
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT STEPHEN MINNICK CRNA (OWNER)
(209) 245-5559
Entity
Organization
Contact information
Practice address
11216 TRINITY RIVER DR, RANCHO CORDOVA, CA 95670-2968
(916) 635-6161
Mailing address
PO BOX 34120, RENO, NV 89533-4120
(775) 747-5050
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2712
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2712
CRNA LICENSE
CA
01
—
488921
RN LICENSE
CA
Enumeration date
05/07/2009
Last updated
05/07/2009
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