Provider Demographics
NPI:1811006018
Name:KRAFT, CHARLES GREGORY (EDD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GREGORY
Last Name:KRAFT
Suffix:
Gender:M
Credentials:EDD
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 1161
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-1161
Mailing Address - Country:US
Mailing Address - Phone:831-462-0961
Mailing Address - Fax:
Practice Address - Street 1:409 ALBERTO WAY
Practice Address - Street 2:5
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5407
Practice Address - Country:US
Practice Address - Phone:408-358-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7492103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA537614000Medicare UPIN
CA6139813Medicare UPIN
CA00PL7492Medicare UPIN
CA0007763533Medicare UPIN
CA283336Medicare UPIN