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General NPI Number Information
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NPI Number | 1508987371
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Entity Type | Individual
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Provider Name | JEFFREY JOHN CRUDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1100 S COAST HWY STE 206
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2972
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Country | US
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Telephone | 949-715-6890
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 S COAST HWY STE 206
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2972
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Country | US
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Telephone | 949-715-6890
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C128508
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | C128508
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12581
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME113261
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License Number State | FL
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