Healthcare Provider Details

I. General information

NPI: 1114856580
Provider Name (Legal Business Name): KRYSTAL KRISTINA FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 W 28TH ST
LOS ANGELES CA
90018-2352
US

IV. Provider business mailing address

3910 W 28TH ST
LOS ANGELES CA
90018-2352
US

V. Phone/Fax

Practice location:
  • Phone: 562-341-8300
  • Fax:
Mailing address:
  • Phone: 562-341-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number331267660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: