Individual
DR. EDWARD DAVID CRANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1520 SAN PABLO ST, SUITE 1000, LOS ANGELES, CA 90033-5310
(323) 442-5100
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5100
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G28278
CA
207RP1001X
Pulmonary Disease Physician
Primary
G28278
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G282780
—
CA
01
—
1356390009
GROUP NPI
CA
01
—
CE1617
GROUP RAILROAD MEDICARE
CA
01
—
GR0016910
GROUP MEDICAID PIN
CA
01
—
W11675
GROUP MEDICARE PIN
CA
Enumeration date
02/07/2007
Last updated
03/08/2016
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