Provider Demographics
NPI: | 1104851443 |
---|---|
Name: | CRAIG, JOCELYN BENNETT (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | JOCELYN |
Middle Name: | BENNETT |
Last Name: | CRAIG |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2888 LONG BEACH BLVD STE 325 |
Mailing Address - Street 2: | |
Mailing Address - City: | LONG BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90806-7503 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 562-426-4904 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2888 LONG BEACH BLVD STE 325 |
Practice Address - Street 2: | |
Practice Address - City: | LONG BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90806-7503 |
Practice Address - Country: | US |
Practice Address - Phone: | 562-426-4904 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-12 |
Last Update Date: | 2022-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A80920 | 207V00000X, 207VG0400X, 207VF0040X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Urogynecology and Reconstructive Pelvic Surgery |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |