Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A88400 | CA |
NPI | 1215014980 |
---|---|
Provider Name | Dr. Jonathan Wayne Crabb |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Glendale, CA 91208-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/09/2020 |