Provider Demographics
NPI:1114476702
Name:ROBINSON, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 TURKEY LAKE RD
Mailing Address - Street 2:P.O BOX 692327
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-7501
Mailing Address - Country:US
Mailing Address - Phone:510-356-8711
Mailing Address - Fax:
Practice Address - Street 1:5026 TIDEVIEW CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8800
Practice Address - Country:US
Practice Address - Phone:510-356-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other