Healthcare Provider Details

I. General information

NPI: 1649702507
Provider Name (Legal Business Name): CRYSTAL SOBRIAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10772 OAK ST
LOS ALAMITOS CA
90720-2300
US

IV. Provider business mailing address

PO BOX 333
LOS ALAMITOS CA
90720-0333
US

V. Phone/Fax

Practice location:
  • Phone: 562-857-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: