Healthcare Provider Details

I. General information

NPI: 1104713221
Provider Name (Legal Business Name): MRS. CRYSTAL ANN URRUTIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

IV. Provider business mailing address

7137 GILLINGHAM CT
SYLVANIA OH
43560-1139
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-2888
  • Fax:
Mailing address:
  • Phone: 419-460-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: