Healthcare Provider Details

I. General information

NPI: 1659873271
Provider Name (Legal Business Name): CRANIAL TECHNOLOGIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL STE 130
ASHBURN VA
20147-3393
US

IV. Provider business mailing address

1405 W AUTO DR FL 2
TEMPE AZ
85284-1227
US

V. Phone/Fax

Practice location:
  • Phone: 844-447-5894
  • Fax: 844-447-5895
Mailing address:
  • Phone: 844-447-5894
  • Fax: 844-447-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: OUMOU K BAH
Title or Position: COMPLIANCE & MEDICAID SPECIALIST
Credential:
Phone: 602-393-8188