Provider Demographics
NPI:1518135987
Name:CRAWFORD, CASSANDRA RENEE
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:RENEE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 S MOUNTAIN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:909-458-1243
Mailing Address - Fax:909-458-1352
Practice Address - Street 1:2314 S MOUNTAIN AVE
Practice Address - Street 2:STE B
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:909-458-1243
Practice Address - Fax:909-458-1352
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator