Healthcare Provider Details

I. General information

NPI: 1811252018
Provider Name (Legal Business Name): MR. JOSEPH MICHAEL CRAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 FOXWORTHY AVE
SAN JOSE CA
95118-1032
US

IV. Provider business mailing address

1556 FOXWORTHY AVE
SAN JOSE CA
95118-1032
US

V. Phone/Fax

Practice location:
  • Phone: 530-209-1136
  • Fax:
Mailing address:
  • Phone: 530-209-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: