Healthcare Provider Details

I. General information

NPI: 1881178119
Provider Name (Legal Business Name): CRYSTAL CUEVAS NAVARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ATLANTIC AVE STE 101
ALAMEDA CA
94501-1188
US

IV. Provider business mailing address

600 W 20TH ST
ANTIOCH CA
94509-2518
US

V. Phone/Fax

Practice location:
  • Phone: 925-206-0804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: