Healthcare Provider Details

I. General information

NPI: 1366307977
Provider Name (Legal Business Name): KRYSTAL SARABIA-ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SESPE AVE
FILLMORE CA
93015-1918
US

IV. Provider business mailing address

116 WISTERIA ST
FILLMORE CA
93015-2244
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-8045
  • Fax: 805-524-6060
Mailing address:
  • Phone: 805-746-5028
  • Fax: 805-524-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250166098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: