Healthcare Provider Details

I. General information

NPI: 1922469931
Provider Name (Legal Business Name): DAVID CRAGO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 05/28/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDOS/SGOW 101 BODIN CIRCLE
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

CORPUS CHRISTI VA CLINIC 5283 OLD BROWNSVILLE RD
CORPUS CHRISTI TX
78405
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone: 650-444-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: