Provider Demographics
NPI:1932979069
Name:CROCKAM, DEIDRIA CIERRIA
Entity Type:Individual
Prefix:MS
First Name:DEIDRIA
Middle Name:CIERRIA
Last Name:CROCKAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CIERRIA
Other - Middle Name:LEYAZHIE'
Other - Last Name:CALIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3701 SANTA ROSALIA DR # 1165
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3603
Mailing Address - Country:US
Mailing Address - Phone:310-488-0976
Mailing Address - Fax:
Practice Address - Street 1:2845 W 42ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008
Practice Address - Country:US
Practice Address - Phone:310-488-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula