Provider Demographics
NPI:1417521865
Name:CRAWFORD, PAMELA (LAC, MS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2625 ALCATRAZ AVE # 336
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2702
Mailing Address - Country:US
Mailing Address - Phone:510-655-4781
Mailing Address - Fax:510-903-2333
Practice Address - Street 1:6550 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1028
Practice Address - Country:US
Practice Address - Phone:510-655-4781
Practice Address - Fax:510-903-2333
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist