Healthcare Provider Details

I. General information

NPI: 1851122832
Provider Name (Legal Business Name): CRISTAL CORIA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 N 935 E STE 7
LAYTON UT
84040-7318
US

IV. Provider business mailing address

389 DOWNS DR
OGDEN UT
84404-7328
US

V. Phone/Fax

Practice location:
  • Phone: 801-771-0273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-367574
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: