Provider Demographics
NPI:1679294979
Name:CRAZE, CHANNING
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:
Last Name:CRAZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45443 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2219
Mailing Address - Country:US
Mailing Address - Phone:240-727-3569
Mailing Address - Fax:
Practice Address - Street 1:23860 HAWTHORNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-8201
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:310-791-3084
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator