Healthcare Provider Details

I. General information

NPI: 1124895453
Provider Name (Legal Business Name): DAVID CROSBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

459 S MANLEY RD
RIPON CA
95366-2937
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-7177
  • Fax:
Mailing address:
  • Phone: 209-499-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number16556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: