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General NPI Number Information
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NPI Number | 1487247805
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Entity Type | Individual
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Provider Name | CRESPA CRISTE DE LEON CPN, MSN-FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 1805 N CALIFORNIA ST STE 409
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City | STOCKTON
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State | CA
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Zip | 95204-6033
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Country | US
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Telephone | 209-476-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 8872 BERGAMO CIR
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City | STOCKTON
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State | CA
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Zip | 95212-3050
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Country | US
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Telephone | 209-327-8731
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015937
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License Number State | CA
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