Provider Demographics
NPI:1083950828
Name:TANGLAO, CRISPULO T (CADC-2)
Entity Type:Individual
Prefix:MR
First Name:CRISPULO
Middle Name:T
Last Name:TANGLAO
Suffix:
Gender:M
Credentials:CADC-2
Other - Prefix:MR
Other - First Name:CRISPULO
Other - Middle Name:T
Other - Last Name:TANGLAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ICADC
Mailing Address - Street 1:2001 PARKSIDE DR
Mailing Address - Street 2:2001 PARKSIDE DRIVE
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2527
Mailing Address - Country:US
Mailing Address - Phone:551-804-0038
Mailing Address - Fax:
Practice Address - Street 1:2100 NAPA VALLEJO HWY # 253M1&M2
Practice Address - Street 2:2100 NAPA VALLEJO HWY, BLGD 253 M1&M2
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-257-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA853510101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)