Provider Demographics
NPI:1265411730
Name:ENDO, CRAIG YOSHIO (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:YOSHIO
Last Name:ENDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-8628
Mailing Address - Country:US
Mailing Address - Phone:909-392-3230
Mailing Address - Fax:909-392-3224
Practice Address - Street 1:2333 FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3027
Practice Address - Country:US
Practice Address - Phone:909-392-6501
Practice Address - Fax:909-469-2136
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674920Medicaid
CA1265411730Medicaid
CA00A674920Medicaid