MEDICARE: CRYSTAL ALEJANDRA PEREZ

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	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1578394029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ALEJANDRA PEREZ

Provider Business Mailing Address
First Line	:	341 ANZA ST APT 207B
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4367
Country	:	US
Telephone Number	:	669-327-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	341 ANZA ST APT 207B
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4367
Country	:	US
Telephone Number	:	669-327-7657
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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Directions to “ CRYSTAL ALEJANDRA PEREZ ” Practice Location

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