Provider Demographics
NPI:1972888774
Name:REDDINGIUS, JASON ANTHONY (CRNA)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:REDDINGIUS
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 1:16643 ROCKY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6545
Mailing Address - Country:US
Mailing Address - Phone:951-231-8105
Mailing Address - Fax:
Practice Address - Street 1:16643 ROCKY CREEK DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-6545
Practice Address - Country:US
Practice Address - Phone:951-231-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4114367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered