Provider Demographics
NPI:1457011892
Name:CRESPO, PAUL ADAM (OTC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ADAM
Last Name:CRESPO
Suffix:
Gender:M
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5063 PIKES CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5417
Mailing Address - Country:US
Mailing Address - Phone:951-946-8138
Mailing Address - Fax:
Practice Address - Street 1:5063 PIKES CT
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-5417
Practice Address - Country:US
Practice Address - Phone:951-946-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20-1117246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant