Provider Demographics
NPI:1699779272
Name:PARENT, CRAIG RANDALL (DPM)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:RANDALL
Last Name:PARENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-383-3668
Mailing Address - Fax:805-383-3661
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-383-3668
Practice Address - Fax:805-383-3661
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-10-14
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
CAE4710213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4710OtherMEDICARE ID
CAE4710Medicare PIN
CAE4710OtherMEDICARE ID