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General NPI Number Information
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NPI Number | 1720814031
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Entity Type | Individual
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Provider Name | KRYSTAL VICTORIA ROA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 2828 FORD ST
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City | OAKLAND
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State | CA
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Zip | 94601-2114
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Country | US
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Telephone | 510-268-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 4307 FOOTHILL WAY
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City | PITTSBURG
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State | CA
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Zip | 94565-6208
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Country | US
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Telephone | 925-852-4976
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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