Healthcare Provider Details

I. General information

NPI: 1255680245
Provider Name (Legal Business Name): CRYSTAL FAITH SALE CAJILOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 37TH AVE 3RD FLOOR
SAN MATEO CA
94403-4324
US

IV. Provider business mailing address

610 GATES ST
SAN FRANCISCO CA
94110-6056
US

V. Phone/Fax

Practice location:
  • Phone: 650-537-5262
  • Fax:
Mailing address:
  • Phone: 510-875-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: