Provider Demographics
NPI:1497337356
Name:CRAWFORD, THOMAS L
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:CRAWFORD
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 1:1608 CHAMBERLIN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3772
Mailing Address - Country:US
Mailing Address - Phone:951-210-2743
Mailing Address - Fax:
Practice Address - Street 1:1608 CHAMBERLIN CREEK WAY
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3772
Practice Address - Country:US
Practice Address - Phone:951-210-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)