Healthcare Provider Details

I. General information

NPI: 1316841760
Provider Name (Legal Business Name): KRYSTAL BALE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 WARNER AVE APT A
HUNTINGTON BEACH CA
92647-5125
US

IV. Provider business mailing address

6132 WARNER AVE APT A
HUNTINGTON BEACH CA
92647-5125
US

V. Phone/Fax

Practice location:
  • Phone: 720-243-2994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA69076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: