Healthcare Provider Details

I. General information

NPI: 1194011858
Provider Name (Legal Business Name): JESSICA ANNE CRAIG D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17272 NEWHOPE ST
FOUNTAIN VALLEY CA
92708-4210
US

IV. Provider business mailing address

17272 NEWHOPE ST
FOUNTAIN VALLEY CA
92708-4210
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-7268
  • Fax: 714-434-7042
Mailing address:
  • Phone: 714-754-7268
  • Fax: 714-434-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT37550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: