Healthcare Provider Details

I. General information

NPI: 1982034419
Provider Name (Legal Business Name): MRS. CRYSTAL WHITEHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 ARNOLD DR STE 110
MARTINEZ CA
94553-4189
US

IV. Provider business mailing address

2311 LOVERIDGE RD 2ND FLOOR
PITTSBURG CA
94565-5117
US

V. Phone/Fax

Practice location:
  • Phone: 925-597-5971
  • Fax:
Mailing address:
  • Phone: 925-431-2634
  • Fax: 925-431-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: