Healthcare Provider Details

I. General information

NPI: 1043754724
Provider Name (Legal Business Name): CRYSTAL CONTRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE SUITE #201
WHITTIER CA
90602-3158
US

IV. Provider business mailing address

11006 CULTURA ST
SANTA FE SPRINGS CA
90670-2350
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: