Healthcare Provider Details

I. General information

NPI: 1154212553
Provider Name (Legal Business Name): JEFFERY CRAWFORD JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 ROSCOE BLVD STE 100
VAN NUYS CA
91406-1206
US

IV. Provider business mailing address

12070 TELEGRAPH RD STE 207
SANTA FE SPRINGS CA
90670-8213
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 562-777-7500
  • Fax: 562-777-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: