Healthcare Provider Details

I. General information

NPI: 1003058678
Provider Name (Legal Business Name): THOMAS CRESANTE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2009
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST KAISER PERMANENTE WALNUT CREEK ATTN: HBS DEPT
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

1425 S MAIN ST KAISER PERMANENTE WALNUT CREEK ATTN: HBS DEPT
WALNUT CREEK CA
94596-5318
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A11480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: