MEDICARE: CRISTAL NUNEZ RODRIGUEZ SLPA

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	2355S0801X	Speech-Language Assistant	5782	CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1316411838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTAL NUNEZ RODRIGUEZ SLPA

Provider Business Mailing Address
First Line	:	502 8TH ST
Second Line	:
City	:	MC FARLAND
State	:	CA
Zip	:	93250-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 NEW STINE RD STE 100
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-3698
Country	:	US
Telephone Number	:	661-778-3636
Fax Number	:

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

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/24/2020

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