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General NPI Number Information
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NPI Number | 1174221717
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Entity Type | Individual
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Provider Name | KRYSTIN PRINCE
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Gender | Female
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 1365 OHIO AVE APT 304
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City | LONG BEACH
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State | CA
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Zip | 90804-2450
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Country | US
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Telephone | 909-663-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 131 S FAHRION PL APT E
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City | ANAHEIM
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State | CA
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Zip | 92805-4270
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Country | US
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Telephone | 424-245-9466
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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