Healthcare Provider Details

I. General information

NPI: 1972201416
Provider Name (Legal Business Name): DAVID CRABTREE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 07/25/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 NORMAL ST UNIT 104
SAN DIEGO CA
92103-3586
US

IV. Provider business mailing address

3935 NORMAL ST APT 104
SAN DIEGO CA
92103-3586
US

V. Phone/Fax

Practice location:
  • Phone: 619-514-3588
  • Fax: 619-367-6663
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID CRABTREE
Title or Position: OWNER
Credential: MD
Phone: 619-373-2843