Healthcare Provider Details

I. General information

NPI: 1861033896
Provider Name (Legal Business Name): KRYSTAL POMBO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

269 W POWERS AVE
CLOVIS CA
93619-3749
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4500
  • Fax:
Mailing address:
  • Phone: 559-304-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number3402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number3402
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number661040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: