Healthcare Provider Details

I. General information

NPI: 1134767593
Provider Name (Legal Business Name): CRYSTAL MELODY LOUCEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL MELODY ACUNA

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 21ST AVE APT 102
SAN FRANCISCO CA
94122-4448
US

IV. Provider business mailing address

1801 21ST AVE APT 102
SAN FRANCISCO CA
94122-4448
US

V. Phone/Fax

Practice location:
  • Phone: 949-892-9231
  • Fax:
Mailing address:
  • Phone: 949-892-9231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number824984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: