MEDICARE: KRYSTAL GEORGE RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86107910	CA
2	106H00000X	Marriage & Family Therapist	154808	CA

General Provider Information

NPI Number	:	1255088456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL GEORGE RDN

Provider Business Mailing Address
First Line	:	4328 FARRAGUT ST # 1010
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2032
Country	:	US
Telephone Number	:	909-913-4581
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 FARRAGUT ST # 1010
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2032
Country	:	US
Telephone Number	:	909-913-4581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	06/08/2026

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