Basic Information
| Provider Information | |||||||||
| NPI: | 1568515195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIGS THOMAS | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | LATREASE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 CULVER BLVD | ||||||||
| Address2: | APT. 4 | ||||||||
| City: | PLAYA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902937763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232983681 | ||||||||
| FaxNumber: | 3232920053 | ||||||||
| Practice Location | |||||||||
| Address1: | 3751 STOCKER ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | VIEW PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232983681 | ||||||||
| FaxNumber: | 3232920053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163W00000X | 547387 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 19205 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 19205 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.