Healthcare Provider Details

I. General information

NPI: 1699571364
Provider Name (Legal Business Name): ELIZABETH CRESPO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 W 25TH ST
CLEVELAND OH
44109-1617
US

IV. Provider business mailing address

3159 W 25TH ST
CLEVELAND OH
44109-1617
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-4876
  • Fax: 407-650-2754
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: