Healthcare Provider Details

I. General information

NPI: 1265528236
Provider Name (Legal Business Name): BEVERLY V CRAWFORD RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/29/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST
LOS ANGELES CA
90033-1317
US

IV. Provider business mailing address

1920 MARENGO ST
LOS ANGELES CA
90033-1317
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-4462
  • Fax: 323-225-5844
Mailing address:
  • Phone: 323-223-4462
  • Fax: 323-225-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN580404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: