Organization
COLUMBIA GORGE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID C BULLOCK CRNA (PRESIDENT)
(714) 347-1010
Entity
Organization
Contact information
Practice address
1020 WEBBER ST, THE DALLES, OR 97058-3749
(541) 769-0426
(541) 769-0431
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 347-1010
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200860006CRNA
OR
Other
Enumeration date
05/30/2013
Last updated
03/04/2014
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