Healthcare Provider Details

I. General information

NPI: 1326540162
Provider Name (Legal Business Name): CRYSTAL MARIE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S QUINTANA DR
ANAHEIM CA
92807-4029
US

IV. Provider business mailing address

233 S QUINTANA DR
ANAHEIM CA
92807-4029
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1004
  • Fax:
Mailing address:
  • Phone: 714-202-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: