Healthcare Provider Details

I. General information

NPI: 1699359422
Provider Name (Legal Business Name): RACHAEL JAEDE CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1615
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY STE 443
MISSION VIEJO CA
92691-6375
US

V. Phone/Fax

Practice location:
  • Phone: 714-463-7505
  • Fax:
Mailing address:
  • Phone: 951-218-5435
  • Fax: 949-506-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPA60682
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: