Healthcare Provider Details

I. General information

NPI: 1255298204
Provider Name (Legal Business Name): CRYSTAL MOLINAR MPSS-KZTGEX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 WILSHIRE ST
RIVERSIDE CA
92501-2144
US

IV. Provider business mailing address

2452 WILSHIRE ST
RIVERSIDE CA
92501-2144
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-6631
  • Fax: 951-682-6614
Mailing address:
  • Phone: 951-682-6631
  • Fax: 951-682-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1449430726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: