Healthcare Provider Details

I. General information

NPI: 1780815357
Provider Name (Legal Business Name): CRYSTAL FELICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 WYOMING BLVD NE BUILDING I SUITE 3
ALBUQUERQUE NM
87109-3932
US

IV. Provider business mailing address

10829 MALAGUENA LN NE
ALBUQUERQUE NM
87111-6821
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-2687
  • Fax: 800-872-8857
Mailing address:
  • Phone: 505-263-2687
  • Fax: 800-872-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: