Provider Demographics
NPI:1861065039
Name:CRAWFORD-DAVIS, TASHA DAVETTE
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:DAVETTE
Last Name:CRAWFORD-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 GREAT FALLS WAY APT 47
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3071
Mailing Address - Country:US
Mailing Address - Phone:916-272-3667
Mailing Address - Fax:
Practice Address - Street 1:3099 GREAT FALLS WAY APT 47
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3071
Practice Address - Country:US
Practice Address - Phone:916-272-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3780026342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company