Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Wilbert Tirtadinata

Individual provider Certified Registered Nurse Anesthetist · NPI 1578177630

Wilbert Tirtadinata is a Certified Registered Nurse Anesthetist (CRNA) in Oakland, California. Qualified in 2022, 4 years ago. Practices with Blue Eagle Anesthesia Inc a Professional Corporation, a 25-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
4
Licensed in
CA
In the registry since
2020
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Practice location Address checks out

3600 Broadway
Oakland, CA 94611-5730
Phone: (510) 752-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 95002000 (CA)

Record details

NPI number1578177630
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 4, 2020
Last updated in NPPESMarch 13, 2024
Certification dateMarch 13, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Blue Eagle Anesthesia Inc A Professional Corporation — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Oakland