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General NPI Number Information
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NPI Number | 1225546997
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Entity Type | Individual
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Provider Name | LATOSHA RAE CRUNK
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Gender | Female
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 2141 PALOMAR AIRPORT RD STE 350
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City | CARLSBAD
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State | CA
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Zip | 92011-1451
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Country | US
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Telephone | 951-492-8776
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Fax |
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Provider Business Mailing Address
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Address Line | 3171 CAMARILLO AVE
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City | OCEANSIDE
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State | CA
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Zip | 92056-4340
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Country | US
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Telephone | 951-492-8776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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