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General NPI Number Information
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NPI Number | 1114612314
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Entity Type | Organization
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Legal Business Name | KRYSTAL CLEAR IMAGING LLC
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 7007 JEFFERSON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4450
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Country | US
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Telephone | 505-303-0372
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 PEPPOLI LOOP SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-8775
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Country | US
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Telephone | 505-303-0372
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL GRIEGO
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Credential |
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Telephone | 505-977-4788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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