Healthcare Provider Details

I. General information

NPI: 1083349955
Provider Name (Legal Business Name): ALEXIS B CRAWFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 CITRACADO PKWY STE 220
ESCONDIDO CA
92029-4151
US

IV. Provider business mailing address

2130 CITRACADO PKWY STE 220
ESCONDIDO CA
92029-4151
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-4789
  • Fax: 760-743-4779
Mailing address:
  • Phone: 760-743-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: