MEDICARE: DR. CRYSTAL L HNATKO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	20A11584	CA

General Provider Information

NPI Number	:	1255325577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL L HNATKO D.O.

Provider Business Mailing Address
First Line	:	1 QUALITY DR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9494
Country	:	US
Telephone Number	:	707-651-2549
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 QUALITY DR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9494
Country	:	US
Telephone Number	:	707-651-2549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	04/19/2023

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