Healthcare Provider Details

I. General information

NPI: 1255251195
Provider Name (Legal Business Name): PETRO C CRISOSTOMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINDSOR PARK DR
BAKERSFIELD CA
93311-3586
US

IV. Provider business mailing address

500 WINDSOR PARK DR
BAKERSFIELD CA
93311-3586
US

V. Phone/Fax

Practice location:
  • Phone: 661-800-8055
  • Fax:
Mailing address:
  • Phone: 661-800-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number2700188462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: