Healthcare Provider Details

I. General information

NPI: 1962984336
Provider Name (Legal Business Name): LAWRENCE ANTHONY CRISOSTOMO MSN, AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

1300 N C ST
OXNARD CA
93030-4006
US

V. Phone/Fax

Practice location:
  • Phone: 510-350-2600
  • Fax:
Mailing address:
  • Phone: 805-983-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95009323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: