Healthcare Provider Details

I. General information

NPI: 1760193510
Provider Name (Legal Business Name): MRS. AUDREY MARIE CRENSHAW-WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

IV. Provider business mailing address

4930 NAPLES ST
SAN DIEGO CA
92110-3820
US

V. Phone/Fax

Practice location:
  • Phone: 909-660-0097
  • Fax:
Mailing address:
  • Phone: 619-276-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-174231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: