Healthcare Provider Details

I. General information

NPI: 1144420811
Provider Name (Legal Business Name): CARL ALAN CROUTCH AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY ROOM 2201
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY ROOM 2201
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4617
  • Fax:
Mailing address:
  • Phone: 510-204-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU 421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: