Healthcare Provider Details

I. General information

NPI: 1679286223
Provider Name (Legal Business Name): GISSELL CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S MAYFLOWER AVE STE 220
MONROVIA CA
91016-5239
US

IV. Provider business mailing address

2035 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax:
Mailing address:
  • Phone: 855-425-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: