Provider Demographics
NPI:1568515195
Name:CRAIGS THOMAS, TONI LATREASE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:LATREASE
Last Name:CRAIGS THOMAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:400 CULVER BLVD
Mailing Address - Street 2:APT. 4
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7763
Mailing Address - Country:US
Mailing Address - Phone:323-298-3681
Mailing Address - Fax:323-292-0053
Practice Address - Street 1:3751 STOCKER ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008
Practice Address - Country:US
Practice Address - Phone:323-298-3681
Practice Address - Fax:323-292-0053
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA547387163W00000X
CA19205363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner