Provider Demographics
NPI:1447789151
Name:CRESPO, DORA ELVA I (RN)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:ELVA
Last Name:CRESPO
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PICO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3503
Mailing Address - Country:US
Mailing Address - Phone:818-627-4721
Mailing Address - Fax:
Practice Address - Street 1:1212 PICO ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3503
Practice Address - Country:US
Practice Address - Phone:818-627-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632005163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care