Provider Demographics
NPI:1164128708
Name:BIALOZOR, KRYSTA JORDAN
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:JORDAN
Last Name:BIALOZOR
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 1:7147 NE ROCKY BROOK ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7279
Mailing Address - Country:US
Mailing Address - Phone:719-429-2646
Mailing Address - Fax:
Practice Address - Street 1:16365 NW TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-828-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program