Individual
JENNIFER TAITAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6041 CADILLAC AVE, LOS ANGELES, CA 90034-1702
(323) 857-2000
Mailing address
4433 VERDUGO RD, LOS ANGELES, CA 90065-4828
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
521573
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000579
CA
390200000X
Student in an Organized Health Care Education/Training Program
649134
CA
Other
Enumeration date
07/12/2016
Last updated
12/04/2021
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