Carla N Crespo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

18086 Issued in CA

Practice address

4640 Admiralty Way Ste 1000
Marina del Rey, CA 90292-6672

Phone

(310) 300-1779

Fax

(310) 494-0509

NPI assigned

Mar 1, 2007

Last updated

Nov 1, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2018 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grant Stevens, M.D., Inc

  • Plastic Surgery Physician
  • Marina del Rey, CA
  • NPI 1639444714
  NPD (past)
• Marina Dermatology Associates

  dba Comprehensive Skin Care

  • Dermatology Physician
  • Marina del Rey, CA
  • NPI 1356778476
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572566400000",
    "number": "1205964020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 1000",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926672",
            "telephone_number": "310-300-1779",
            "fax_number": "310-494-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 1000",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926672",
            "telephone_number": "310-300-1779",
            "fax_number": "310-494-0509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4640 Admiralty Way Ste 1000",
            "address_purpose": "LOCATION",
            "city": "Marina Del Rey",
            "state": "CA",
            "postal_code": "90292",
            "country_code": "US",
            "telephone_number": "310-956-1529",
            "fax_number": "310-494-0509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRESPO",
        "first_name": "CARLA",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2019-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "18086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Costco Wholesale Corporation
• Costco Wholesale Corporation (Costco Hearing Aid #479)
• Cynthia Joy Cotharn, M.D.
• Katherine Price Cottle
• Caryn H Coulam, LMFT
• Charles William Crook
• Tina R Crowe, MSW
• Erin Crymes
• Curtis F. Veal, MD, Inc
• Cyh Medical Group (de), P.a.

• Physician Assistant in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.