Provider Demographics
NPI:1366776205
Name:BAIROS, JOHNNY (CRNA)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:BAIROS
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 1:429 MARILYN LANE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7327
Mailing Address - Country:US
Mailing Address - Phone:951-312-8034
Mailing Address - Fax:
Practice Address - Street 1:900 E WASHINGTON STREET #155
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4196
Practice Address - Country:US
Practice Address - Phone:951-312-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3807367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered