Individual
KEVIN ROSS GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRBA
Contact information
Practice address
6358 SOMBRERO AVE, CYPRESS, CA 90630-5326
(562) 225-0025
Mailing address
6358 SOMBRERO AVE, CYPRESS, CA 90630-5326
(562) 225-0025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
95000397
CA
Other
Enumeration date
07/07/2015
Last updated
01/17/2016
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