Stark, Jacqueline

Stark, Jacqueline is an individual health care provider with primary practice located at 3350 W Ball Rd Anesthesia Department, Anaheim CA 92804-3710. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is her primary health care specialty. Stark, Jacqueline can be contacted via phone (714) 827-6700.

Contact Information

Primary practice address
3350 W Ball Rd Anesthesia Department Anaheim CA 92804-3710
Phone: (714) 827-6700
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X R148323 Maryland
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 3393 California

Profile Details

NPI number 1396742284
LBN Legal business name Stark, Jacqueline
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Jul 15th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396742284 NPPES
Maryland MEDICAID 000831101

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