Provider Demographics
NPI:1871474866
Name:CRABAJALES, ANDRE ANGELES
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:ANGELES
Last Name:CRABAJALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MERIDIAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5353
Mailing Address - Country:US
Mailing Address - Phone:628-587-7297
Mailing Address - Fax:
Practice Address - Street 1:1505 MERIDIAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5353
Practice Address - Country:US
Practice Address - Phone:628-587-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician