Healthcare Provider Details

I. General information

NPI: 1396241824
Provider Name (Legal Business Name): KAYVA LAUREN CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAVYA L CRAWFORD

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 9TH ST STE B
DEL MAR CA
92014-2805
US

IV. Provider business mailing address

3303 S BOND AVE # MC5E
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 858-260-3393
  • Fax:
Mailing address:
  • Phone: 503-494-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA165819
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA165819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: