Basic Information
| Provider Information | |||||||||
| NPI: | 1801293154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRANE STREET DERMATOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 CRANE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940254257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503230276 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 CRANE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940254257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503230276 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2014 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | BLUMENKRANZ | ||||||||
| AuthorizedOfficialFirstName: | RECIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6503230276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.