Provider Demographics
NPI:1285735258
Name:CRAIG, XANDI JACQUELINE (PA)
Entity type:Individual
Prefix:MS
First Name:XANDI
Middle Name:JACQUELINE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1715 PALAU PL
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3621
Mailing Address - Country:US
Mailing Address - Phone:714-878-6587
Mailing Address - Fax:
Practice Address - Street 1:18300 YORBA LINDA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4052
Practice Address - Country:US
Practice Address - Phone:714-577-6031
Practice Address - Fax:714-577-6034
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15153363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical