Provider Demographics
NPI:1730148743
Name:BARBARA JEAN CRAIGEN
Entity type:Organization
Organization Name:BARBARA JEAN CRAIGEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CRAIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-737-3629
Mailing Address - Street 1:3006 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3238
Mailing Address - Country:US
Mailing Address - Phone:323-737-3629
Mailing Address - Fax:323-737-3710
Practice Address - Street 1:3006 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3238
Practice Address - Country:US
Practice Address - Phone:323-737-3629
Practice Address - Fax:323-737-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103410332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4290230001OtherPROVIDER ID NUMBER