Provider Demographics
NPI:1740302231
Name:CRESPO, DIANA A (CPHT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:A
Last Name:CRESPO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COLCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:READVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2340
Mailing Address - Country:US
Mailing Address - Phone:617-364-0905
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA924183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician