Provider Demographics
NPI:1124057450
Name:GRIFFIS, CHARLES ALAN (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALAN
Last Name:GRIFFIS
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 1:1237 CARMONA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2531
Mailing Address - Country:US
Mailing Address - Phone:323-937-9242
Mailing Address - Fax:323-937-9242
Practice Address - Street 1:UCLA DEPARTMENT OF ANESTHESIOLOGY
Practice Address - Street 2:10833 LE CONTE AVE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-206-6158
Practice Address - Fax:310-825-2236
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA476367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNA33829Medicare ID - Type Unspecified