Healthcare Provider Details

I. General information

NPI: 1770746000
Provider Name (Legal Business Name): MELISSA CRASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST SUITE 101-B
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

1725 W 17TH ST SUITE 101-B
SANTA ANA CA
92706-2316
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT23514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: