Healthcare Provider Details

I. General information

NPI: 1942564653
Provider Name (Legal Business Name): DOUGLAS CROWLEY MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 CLAIREMONT DR
SAN DIEGO CA
92117-5831
US

IV. Provider business mailing address

940 BLUEJACK RD
ENCINITAS CA
92024-4061
US

V. Phone/Fax

Practice location:
  • Phone: 858-500-2693
  • Fax:
Mailing address:
  • Phone: 760-815-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA107750
License Number StateCA

VIII. Authorized Official

Name: DOUGLAS MICHAEL CROWLEY
Title or Position: CEO/ SOLE PROVIDER
Credential: MD
Phone: 760-815-7064