Healthcare Provider Details

I. General information

NPI: 1285030999
Provider Name (Legal Business Name): KRYSTAL DANIELS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 HAVEN AVE
RANCHO CUCAMONGA CA
91730-5807
US

IV. Provider business mailing address

11929 MUSCOVEY DR
JURUPA VALLEY CA
91752-2935
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-8684
  • Fax:
Mailing address:
  • Phone: 951-275-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: