Healthcare Provider Details

I. General information

NPI: 1649181462
Provider Name (Legal Business Name): RASOLAN R CROCKER MA. ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 DOUGLAS AVE APT B
OAKLAND CA
94603-2907
US

IV. Provider business mailing address

1968 S COAST HWY # 3372
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 510-363-0351
  • Fax:
Mailing address:
  • Phone: 510-363-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: