Active NPI
Dominique Suzanne Crawford
- Children's Substance Abuse Rehabilitation Facility
- Martinez, CA
National Provider Identifier
1982807665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Children's Substance Abuse Rehabilitation Facility
- License
- 070012BN
- Practice address
- 4645 Pacheco Blvd
Martinez, CA 94553-3625 - Phone
- (925) 646-9270
- Fax
- (925) 646-9276
- NPI assigned
- Jun 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Children's Substance Abuse Rehabilitation Facility | 3245S0500X | 070012BN | CA | Primary |
Addresses
Primary practice location
4645 Pacheco Blvd
Martinez, CA 94553-3625
Mailing address
PO Box 1109
Martinez, CA 94553-0110
Phone (925) 646-9270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070012BN | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982807665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1109",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945530110",
"telephone_number": "925-646-9270",
"fax_number": "925-646-9276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4645 PACHECO BLVD",
"city": "MARTINEZ",
"state": "CA",
"postal_code": "945533625",
"telephone_number": "925-646-9270",
"fax_number": "925-646-9276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRAWFORD",
"first_name": "DOMINIQUE",
"middle_name": "SUZANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "3245S0500X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
"state": "CA",
"license": "070012BN",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinez, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.