Provider Demographics
NPI:1366577314
Name:STEWART, ROBERT TODD (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:STEWART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4008
Mailing Address - Country:US
Mailing Address - Phone:855-759-3633
Mailing Address - Fax:855-759-3633
Practice Address - Street 1:1127 LOMA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4008
Practice Address - Country:US
Practice Address - Phone:855-759-3633
Practice Address - Fax:855-759-3633
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN586748163W00000X
CA3434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse