Healthcare Provider Details

I. General information

NPI: 1245076033
Provider Name (Legal Business Name): CRYSTAL LEILA HATSUMI ISHIHARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 EUCLID ST STE 495
GARDEN GROVE CA
92840-9209
US

IV. Provider business mailing address

1633 E 4TH ST STE 150
SANTA ANA CA
92701-5170
US

V. Phone/Fax

Practice location:
  • Phone: 323-741-4744
  • Fax:
Mailing address:
  • Phone: 323-741-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: