Provider Demographics
NPI:1497314058
Name:CROFUT, STEVE P
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:P
Last Name:CROFUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N B ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6901
Mailing Address - Country:US
Mailing Address - Phone:805-737-6690
Mailing Address - Fax:805-737-6670
Practice Address - Street 1:117 N B ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6901
Practice Address - Country:US
Practice Address - Phone:805-373-6690
Practice Address - Fax:805-737-6670
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker