Provider Demographics
NPI:1770688814
Name:CREMATA, EDWARD ELIZONDO (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ELIZONDO
Last Name:CREMATA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39140 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1612
Mailing Address - Country:US
Mailing Address - Phone:510-796-2225
Mailing Address - Fax:925-952-4349
Practice Address - Street 1:39140 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1612
Practice Address - Country:US
Practice Address - Phone:510-796-2225
Practice Address - Fax:510-792-0802
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14349111N00000X
CA95013805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor