Healthcare Provider Details

I. General information

NPI: 1649157827
Provider Name (Legal Business Name): MICHAEL K CROWDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST
ORANGE CA
92868-4507
US

IV. Provider business mailing address

500 S MAIN ST
ORANGE CA
92868-4507
US

V. Phone/Fax

Practice location:
  • Phone: 657-565-3259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number01141407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number01141407
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01141407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: