Healthcare Provider Details

I. General information

NPI: 1578390373
Provider Name (Legal Business Name): CRYSTAL MAC GUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL SILVA PPS

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W FRANCIS ST
ONTARIO CA
91762-6311
US

IV. Provider business mailing address

715 W FRANCIS ST
ONTARIO CA
91762-6311
US

V. Phone/Fax

Practice location:
  • Phone: 909-984-1759
  • Fax:
Mailing address:
  • Phone: 909-984-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220251655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: