MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) – Certified Registered Nurse Anesthetist, NPI 1134218969

Certified Registered Nurse Anesthetist

MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) is a healthcare provider. based in Santa ana, California. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials C.R.N.A., MSN. They hold a License No. 489087 (CA). The NPI Number for MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) is 1134218969

Main info

Male

Sole Proprietor

23 Years Of Experience

Accepts Medicare Assignment

Name

MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN)

NPI

1134218969

Phone

(562) 544-8804

Address

902 N GRAND AVE

Enumeration Date

12 October 2006

Last Update Date

1 October 2010

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6613244647

Graduation Year

2003 (23 years ago)

PAC ID

0143110759

Group Practice PAC ID

5698131969

Professional Enrollment ID

I20040317001312

Address ID

CA933012237BA420XXSTXX300

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience56

Completeness75

Years active:19State licenses:2Digital endpointsOther names

2,470 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in CA

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Provider Addresses for MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN)

902, North Grand Avenue, Saddleback View, Santa Ana, Orange County, California, 92701, United States
SANTA ANA, CA 927014218
Phone: (562) 544-8804
Type: Location
5701, East 2nd Street, Long Beach, Los Angeles County, California, 90803, United States
#8
LONG BEACH, CA 908035072
Phone: (562) 439-1609
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-03-17

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

Medicare enrolled
On CMS revalidation list
Due date assigned
Revalidate in PECOS

CMS enrollment records

Enrollment ID	Type	Specialty	State	Due date
I20040317001312	I	Certified Registered Nurse Anesthetist (Crna)	CA	TBD

What to do next

No action required while the due date shows TBD.
Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 92701)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5698131969View full group profile

Name	Specialty	State
MICHAEL V HALL (CRNA)	Certified Registered Nurse Anesthetist (Crna)	CA
PRAVEEN K DAVULURI (MD)	A N E S T H E S I O L O G Y	CA
DR. THOMAS C YEE (M.D.)	Pain Management, Anesthesiology, Addiction Medicine	NV
FATIMA PADRON	Certified Registered Nurse Anesthetist (Crna)	CA
MANOJ MADHU SANGORAM (D.O.)	A N E S T H E S I O L O G Y	NY
RODRIGO FERNANDO LOPEZ (CRNA)	Certified Registered Nurse Anesthetist (Crna)	CA
MR. SOHEIL ETESHAM (MD)	A N E S T H E S I O L O G Y	CA
MOUSSA TAMER (M.D.)	A N E S T H E S I O L O G Y	CA
DR. MARICEL A. ISIDRO-REIGHARD (CRNA)	Certified Registered Nurse Anesthetist (Crna)	CA
LISA LEE CAMERINO (MD)	A N E S T H E S I O L O G Y	HI

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Frequently asked questions

What number should I use to identify MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) for billing?

Administrative and clinical systems typically use NPI 1134218969 for MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN).

Does the public listing show MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) as active?

MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN)'s NPI record reflects an active status in NPPES.

Which specialty label fits MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN)?

NPPES ties MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) to Certified Registered Nurse Anesthetist in the taxonomy section. Clinical services aligned with this taxonomy classification.

What city is tied to MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN)?

The directory associates MR. BROCK VICTOR NYQUIST (C.R.N.A., MSN) with Santa Ana, California. Check all listed addresses for suites or satellite offices.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.