Healthcare Provider Details

I. General information

NPI: 1871594168
Provider Name (Legal Business Name): LAWRENCE R CRONIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6265 HIGHWAY 9
FELTON CA
95018-9710
US

IV. Provider business mailing address

PO BOX 1279
SANTA CRUZ CA
95061-1279
US

V. Phone/Fax

Practice location:
  • Phone: 831-461-4993
  • Fax: 831-603-6478
Mailing address:
  • Phone: 520-975-8520
  • Fax: 831-603-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG54386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: