Healthcare Provider Details

I. General information

NPI: 1043993389
Provider Name (Legal Business Name): CRYSTAL WIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CENTERPOINTE DR
LA PALMA CA
90623-1028
US

IV. Provider business mailing address

13089 PEYTON DR STE C291
CHINO HILLS CA
91709-6018
US

V. Phone/Fax

Practice location:
  • Phone: 626-399-1228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: