Healthcare Provider Details

I. General information

NPI: 1447358353
Provider Name (Legal Business Name): CRAIG ESSEX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE VACAVILLE PSYCHIATRIC PROGRAM
VACAVILLE CA
95696-8297
US

IV. Provider business mailing address

PO BOX 2297 1600 CALIFORNIA DRIVE
VACAVILLE CA
95696-8297
US

V. Phone/Fax

Practice location:
  • Phone: 707-449-6589
  • Fax: 707-453-7097
Mailing address:
  • Phone: 707-449-6589
  • Fax: 707-453-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number20A 6128
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number730
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: