Healthcare Provider Details

I. General information

NPI: 1255838603
Provider Name (Legal Business Name): CRYSTINE L'HERAUX NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 MT DIABLO CT STE 206
LAFAYETTE CA
94549-4049
US

IV. Provider business mailing address

7703 VERNA WAY
LUCERNE CA
95458-8593
US

V. Phone/Fax

Practice location:
  • Phone: 925-338-0448
  • Fax: 840-400-1020
Mailing address:
  • Phone: 925-338-0448
  • Fax: 840-400-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008699
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95008699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: