Healthcare Provider Details

I. General information

NPI: 1558064022
Provider Name (Legal Business Name): PHERCE CRAWFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W 190TH ST STE 300
GARDENA CA
90248-4925
US

IV. Provider business mailing address

4514 8TH AVE
LOS ANGELES CA
90043-1347
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-4523
  • Fax:
Mailing address:
  • Phone: 323-792-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: