Basic Information
| Provider Information | |||||||||
| NPI: | 1558944256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRYSTAL FERNANDEZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 388 E OCEAN BLVD UNIT 1206 | ||||||||
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| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908025271 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4950 BARRANCA PKWY STE 302 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926044631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497273315 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2021 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8189263089 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.