Healthcare Provider Details

I. General information

NPI: 1841744034
Provider Name (Legal Business Name): DAVID CRAFT CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 GENEVA ST
LOS ANGELES CA
90020-1117
US

IV. Provider business mailing address

3160 GENEVA ST
LOS ANGELES CA
90020-1117
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-3151
  • Fax: 213-639-3454
Mailing address:
  • Phone: 213-388-3151
  • Fax: 213-639-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP01992
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: