Provider Demographics
NPI:1225728181
Name:NGUYEN, CRYSTAL (CERTIFIED MASSAGE)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:CERTIFIED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12672 AUDREY CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6013
Mailing Address - Country:US
Mailing Address - Phone:714-423-4503
Mailing Address - Fax:
Practice Address - Street 1:17185 PACIFIC COAST HWY UNIT 1
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:CA
Practice Address - Zip Code:90742-2200
Practice Address - Country:US
Practice Address - Phone:562-588-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist