Provider Demographics
NPI:1740459908
Name:YP CRABB PHD PORFESSIONAL CORPORATION
Entity type:Organization
Organization Name:YP CRABB PHD PORFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANGCHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-685-5668
Mailing Address - Street 1:3311 S RAINBOW BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6596
Mailing Address - Country:US
Mailing Address - Phone:702-685-5668
Mailing Address - Fax:702-685-0534
Practice Address - Street 1:3311 S RAINBOW BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6596
Practice Address - Country:US
Practice Address - Phone:702-685-5668
Practice Address - Fax:702-685-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0523261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457419251Medicaid
NV11828806OtherCAQH
NV1457419251Medicaid
NV=========OtherTRIWEST