Healthcare Provider Details

I. General information

NPI: 1184310492
Provider Name (Legal Business Name): DEAN CREMAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 1ST AVE
SAN DIEGO CA
92103-6599
US

IV. Provider business mailing address

11472 SWAN LAKE DR
SAN DIEGO CA
92131-2917
US

V. Phone/Fax

Practice location:
  • Phone: 619-234-2158
  • Fax: 619-487-9739
Mailing address:
  • Phone: 858-603-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number788882
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number788882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: