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1003964024
KENNETH B LAKE
FONTANA, CA
NPI
1003964024
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: CA NA3286)
Enumeration Date
2007-01-08
Last Update Date
2008-09-15
Business Address
KENNETH B LAKE CRNA
9961 SIERRA AVE
FONTANA, CA 92335-6720
Phone number: 909-427-3910
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Mailing Address
KENNETH B LAKE CRNA
9961 SIERRA AVE
FONTANA, CA 92335-6720
Phone number: 909-427-3910
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