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General NPI Number Information
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NPI Number | 1982416491
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Entity Type | Individual
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Provider Name | MICHAEL DUSHAUN CROOM
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Gender | Male
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | MANUEL A. SALINAS ELEMENTARY SCHOOL 2699 N. CALIFORNIA ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92407
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Country | US
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Telephone | 909-880-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 930 S MOUNT VERNON AVE STE 90
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City | COLTON
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State | CA
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Zip | 92324-3928
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Country | US
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Telephone | 909-660-0097
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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 | CA
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