Healthcare Provider Details

I. General information

NPI: 1336734029
Provider Name (Legal Business Name): KRYSTAL ALLISON CANELLAS SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 ANCHORAGE PL
CHULA VISTA CA
91914-4535
US

IV. Provider business mailing address

865 ANCHORAGE PL
CHULA VISTA CA
91914-4535
US

V. Phone/Fax

Practice location:
  • Phone: 619-271-4957
  • Fax:
Mailing address:
  • Phone: 619-271-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP41067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: