Basic Information
| Provider Information | |||||||||
| NPI: | 1962863613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAROS | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1044 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930351101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168571282 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 315 CAMINO DEL REMEDIO | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056815220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 657841 | NY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 95080485 | CA | Y | Nursing Service Providers | Registered Nurse | 163W00000X | RN194347 | AZ | N | Nursing Service Providers | Registered Nurse |
No ID Information.