Provider Demographics
NPI:1033822127
Name:PUMAREJO, KRYSTLE M (LEP, MS, PPS)
Entity Type:Individual
Prefix:MS
First Name:KRYSTLE
Middle Name:M
Last Name:PUMAREJO
Suffix:
Gender:F
Credentials:LEP, MS, PPS
Other - Prefix:MRS
Other - First Name:KRYSTLE
Other - Middle Name:M
Other - Last Name:OROZCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LEP, MS, PPS
Mailing Address - Street 1:6240 W PALO ALTO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4470 W SUNSET BLVD STE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6309
Practice Address - Country:US
Practice Address - Phone:323-798-7413
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
CALEP3413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool