Basic Information
| Provider Information | |||||||||
| NPI: | 1255517546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNANAN | ||||||||
| FirstName: | CRYSTAL NERENCE | ||||||||
| MiddleName: | GOMEZ | ||||||||
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| Credential: | RPT | ||||||||
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| OtherLastName: | GOMEZ | ||||||||
| OtherFirstName: | CRYSTAL NERENCE | ||||||||
| OtherMiddleName: | DE GUIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2470 MARTIN ANTHONY CT | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953776628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087997760 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2586 BUTHMANN AVE | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953762165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098322273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT32788 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.