Provider Demographics
NPI:1548345143
Name:BARRUGA, MARVIN JAMES LOPEZ (CRNA)
Entity type:Individual
Prefix:
First Name:MARVIN JAMES
Middle Name:LOPEZ
Last Name:BARRUGA
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:PO BOX 4259
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4259
Mailing Address - Country:US
Mailing Address - Phone:562-407-2080
Mailing Address - Fax:562-407-2082
Practice Address - Street 1:850 S ATLANTIC BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6705
Practice Address - Country:US
Practice Address - Phone:909-570-9108
Practice Address - Fax:909-570-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA 2607367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ236442ZOtherPPIN
CACA163207 (RA-SB)Medicare PIN
CACA163206 (RA-RV)Medicare PIN
CACB239480 (RA-OC)Medicare PIN
P25667Medicare UPIN
CACB239481 (RA-LA)Medicare PIN