Provider Demographics
NPI:1659745610
Name:CRAFT, KEVIN EUGENE (LAC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EUGENE
Last Name:CRAFT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ANCHORAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5417
Mailing Address - Country:US
Mailing Address - Phone:310-469-1461
Mailing Address - Fax:
Practice Address - Street 1:770 26TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-5004
Practice Address - Country:US
Practice Address - Phone:310-469-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist