Healthcare Provider Details

I. General information

NPI: 1144211228
Provider Name (Legal Business Name): VICTORIA THERESA CRESCENZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4216
  • Fax: 360-475-4801
Mailing address:
  • Phone: 360-475-4216
  • Fax: 360-475-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number5771059
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberD0047410
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number00048714
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: