Organization
CRESTA VENTOSA INC
Active
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
Update your record
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