Healthcare Provider Details

I. General information

NPI: 1841207495
Provider Name (Legal Business Name): ALFREDO E CRESPO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 VENTURA BLVD SUITE K
STUDIO CITY CA
91604
US

IV. Provider business mailing address

12725 VENTURA BLVD SUITE K
STUDIO CITY CA
91604
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-1348
  • Fax: 818-998-2726
Mailing address:
  • Phone: 818-506-1348
  • Fax: 818-998-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: