Healthcare Provider Details

I. General information

NPI: 1093290645
Provider Name (Legal Business Name): GOLDA ROSETE CROWTHER NPS-RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2018
Last Update Date: 09/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 W SUNSET BLVD
LOS ANGELES CA
90027-5969
US

IV. Provider business mailing address

4867 W SUNSET BLVD
LOS ANGELES CA
90027-5969
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-7920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number33018
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number33018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: