Provider Demographics
NPI:1700017969
Name:CRETH, ROBERT LEANARD (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEANARD
Last Name:CRETH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 MITTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2808
Mailing Address - Country:US
Mailing Address - Phone:408-580-6121
Mailing Address - Fax:
Practice Address - Street 1:871 ENBORG CT
Practice Address - Street 2:UNIT 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2645
Practice Address - Country:US
Practice Address - Phone:408-885-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician