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General NPI Number Information
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NPI Number | 1043081268
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Entity Type | Individual
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Provider Name | CRYSTAL CARRASQUILLO
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Gender | Male
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 1730 S ORANGE AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-4417
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Country | US
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Telephone | 909-570-1546
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 N MOUNTAIN AVE STE B560
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City | UPLAND
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State | CA
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Zip | 91786-3695
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Country | US
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Telephone | 909-529-8965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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