Healthcare Provider Details

I. General information

NPI: 1326317314
Provider Name (Legal Business Name): KRYSTAL C DREISBACH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRYSTAL C LOBETO

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 N FAIR OAKS AVE
PASADENA CA
91103
US

IV. Provider business mailing address

867 N FAIR OAKS AVE
PASADENA CA
91103-3050
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax:
Mailing address:
  • Phone: 909-268-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT88528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: