Healthcare Provider Details

I. General information

NPI: 1225753544
Provider Name (Legal Business Name): CRYSTAL ADILENE NUNEZ ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18900 PROSPECT RD
SARATOGA CA
95070-3499
US

IV. Provider business mailing address

2925 SUNSET WAY APT 8
TRACY CA
95376-1838
US

V. Phone/Fax

Practice location:
  • Phone: 408-626-3408
  • Fax:
Mailing address:
  • Phone: 805-550-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000055327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: