MEDICARE: CRYSTAL FONTE

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	2355S0801X	Speech-Language Assistant	SI6751	FL

General Provider Information

NPI Number	:	1811763097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL FONTE

Provider Business Mailing Address
First Line	:	223 E 52ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1426
Country	:	US
Telephone Number	:	786-312-8596
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 E 52ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1426
Country	:	US
Telephone Number	:	786-312-8596
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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Directions to “ CRYSTAL FONTE ” Practice Location

Language	Start Address	Practice Location

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