Provider Demographics
NPI:1649360678
Name:WESTBROOK, CRAIG SHAW (PA)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:SHAW
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:23741 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6051
Mailing Address - Country:US
Mailing Address - Phone:951-677-1401
Mailing Address - Fax:
Practice Address - Street 1:10800 MAGNOLIA AVE
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3043
Practice Address - Country:US
Practice Address - Phone:951-353-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant