Healthcare Provider Details

I. General information

NPI: 1184365421
Provider Name (Legal Business Name): CRYSTAL MICHELLE MALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 N VENTURA RD
OXNARD CA
93036-2246
US

IV. Provider business mailing address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5718
US

V. Phone/Fax

Practice location:
  • Phone: 805-278-4628
  • Fax:
Mailing address:
  • Phone: 206-948-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: