Healthcare Provider Details

I. General information

NPI: 1346388626
Provider Name (Legal Business Name): CRYSTAL TERRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE
ALAMEDA CA
94501-4320
US

IV. Provider business mailing address

6963 BUCKINGHAM BLVD
BERKELEY CA
94705-1710
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-3700
  • Fax: 510-293-8710
Mailing address:
  • Phone: 510-910-1081
  • Fax: 510-814-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL D. TERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-522-3700