MEDICARE: AXELLE CRAWFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	180716	CA

General Provider Information

NPI Number	:	1871821769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AXELLE CRAWFORD

Provider Business Mailing Address
First Line	:	2075 NAVARRO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 NAVARRO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91103-1555
Country	:	US
Telephone Number	:	626-399-1381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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Directions to “ AXELLE CRAWFORD ” Practice Location

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