Provider Demographics
NPI:1588350961
Name:CRAFTS, FREDERICA (DTCM, DIPLOM, LAC)
Entity type:Individual
Prefix:DR
First Name:FREDERICA
Middle Name:
Last Name:CRAFTS
Suffix:
Gender:F
Credentials:DTCM, DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 LAGOON CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4269
Mailing Address - Country:US
Mailing Address - Phone:617-515-1918
Mailing Address - Fax:
Practice Address - Street 1:6231 HIGHWAY 9 STE A
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9710
Practice Address - Country:US
Practice Address - Phone:669-245-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19524171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist