Provider Demographics
NPI:1659716736
Name:CRUTCHER, ORA MAYANA
Entity Type:Individual
Prefix:
First Name:ORA MAYANA
Middle Name:
Last Name:CRUTCHER
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 1:80 EUREKA SQ STE 111
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2645
Mailing Address - Country:US
Mailing Address - Phone:650-355-7364
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ STE 111
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2645
Practice Address - Country:US
Practice Address - Phone:650-355-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPLEASE CALL ME174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator