Healthcare Provider Details

I. General information

NPI: 1174736730
Provider Name (Legal Business Name): CRYSTAL VO NURSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 LANDESS AVE APT D
SAN JOSE CA
95132-1264
US

IV. Provider business mailing address

3144 LANDESS AVE APT D
SAN JOSE CA
95132-1264
US

V. Phone/Fax

Practice location:
  • Phone: 408-263-1417
  • Fax:
Mailing address:
  • Phone: 408-263-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number163392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: