Healthcare Provider Details

I. General information

NPI: 1083553556
Provider Name (Legal Business Name): CRYSTALYN CABUTOTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28403 S CHRISMAN RD
TRACY CA
95304-8101
US

IV. Provider business mailing address

28403 S CHRISMAN RD
TRACY CA
95304-8101
US

V. Phone/Fax

Practice location:
  • Phone: 209-998-3638
  • Fax: 209-336-0034
Mailing address:
  • Phone: 209-998-3638
  • Fax: 209-336-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: