Healthcare Provider Details

I. General information

NPI: 1477031862
Provider Name (Legal Business Name): CRYSTAL HEARTS HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 ESTRELLA ST
CORONA CA
92880-3304
US

IV. Provider business mailing address

7080 ESTRELLA ST
CORONA CA
92880-3304
US

V. Phone/Fax

Practice location:
  • Phone: 951-407-3620
  • Fax:
Mailing address:
  • Phone: 951-407-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TAMARRALEE CRANDALL
Title or Position: OWNER
Credential: RN
Phone: 951-445-0995