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NPI Code Detail

MEDICARE: GREGORY DIEHL CRAWFORD PSY.D.

MEDICARE: GREGORY DIEHL CRAWFORD PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103G00000XClinical NeuropsychologistPSY28640CA
2103T00000XPsychologistPSY28640CA
3103TC0700XClinical Psychologist28640CA

General Provider Information

NPI Number : 1427310937
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY DIEHL CRAWFORD PSY.D.
Provider Business Mailing Address
First Line : 3350 SHELBY ST STE 200
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5556
Country : US
Telephone Number : 909-935-2385
Fax Number : 909-935-2685
Provider Business Practice Location Address
First Line : 3350 SHELBY ST STE 200
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5556
Country : US
Telephone Number : 909-935-2385
Fax Number : 909-935-2685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2012
Last Update Date : 04/02/2021

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