Healthcare Provider Details

I. General information

NPI: 1568922276
Provider Name (Legal Business Name): LAURA CROCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG 500
SALINAS CA
93906-3100
US

IV. Provider business mailing address

621 KIRKWOOD AVE
SALINAS CA
93901-1412
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-1652
  • Fax: 831-751-0607
Mailing address:
  • Phone: 831-424-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number514695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: