Provider Demographics
NPI:1558143917
Name:CRUMP, EBIDOERE STELLA (HIGH SCHOOL)
Entity Type:Individual
Prefix:MRS
First Name:EBIDOERE
Middle Name:STELLA
Last Name:CRUMP
Suffix:
Gender:F
Credentials:HIGH SCHOOL
Other - Prefix:MRS
Other - First Name:EBIDOERE
Other - Middle Name:STELLA
Other - Last Name:OYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2548 BRAZIL DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6809
Mailing Address - Country:US
Mailing Address - Phone:925-446-9490
Mailing Address - Fax:
Practice Address - Street 1:300 ILENE ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-2631
Practice Address - Country:US
Practice Address - Phone:925-655-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker