Healthcare Provider Details

I. General information

NPI: 1669518106
Provider Name (Legal Business Name): MARY KAY CRAWFORD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28999 OLD TOWN FRONT ST STE 101
TEMECULA CA
92590-2842
US

IV. Provider business mailing address

2245 SERENA HILLS DR
RAMONA CA
92065-3636
US

V. Phone/Fax

Practice location:
  • Phone: 951-261-8392
  • Fax:
Mailing address:
  • Phone: 760-315-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number449175
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number449175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: