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NPI Code Detail

MEDICARE: CRYSTAL IVY CYRUS

MEDICARE: CRYSTAL IVY CYRUS
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
1373H00000XDay Training/Habilitation SpecialistCA

General Provider Information

NPI Number : 1720711419
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL IVY CYRUS
Provider Business Mailing Address
First Line : 760 MOUNTAIN VIEW ST
Second Line :
City : ALTADENA
State : CA
Zip : 91001-4925
Country : US
Telephone Number : 626-798-6793
Fax Number :
Provider Business Practice Location Address
First Line : 760 MOUNTAIN VIEW ST
Second Line :
City : ALTADENA
State : CA
Zip : 91001-4996
Country : US
Telephone Number : 626-798-6793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2022
Last Update Date : 02/06/2026

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Directions to “ CRYSTAL IVY CYRUS ” Practice Location

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