Healthcare Provider Details

I. General information

NPI: 1972869816
Provider Name (Legal Business Name): CRYSTAL MARIE GLASSY D.O., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

IV. Provider business mailing address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax: 951-335-0058
Mailing address:
  • Phone: 844-827-8000
  • Fax: 951-335-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number20A13347
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: