Provider Demographics
NPI:1093358921
Name:SIERRA, CRYSTAL JOY (COTA/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOY
Last Name:SIERRA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:JOY
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5762 OLVERA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-5430
Mailing Address - Country:US
Mailing Address - Phone:619-917-5929
Mailing Address - Fax:
Practice Address - Street 1:690 OTAY LAKES RD STE 110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8904
Practice Address - Country:US
Practice Address - Phone:619-475-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5012224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant