Provider Demographics
NPI:1235705161
Name:CRISOSTOMO, TAYLOR DENAE (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:DENAE
Last Name:CRISOSTOMO
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:DENAE
Other - Last Name:SPITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 ELM ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3672
Mailing Address - Country:US
Mailing Address - Phone:505-242-1010
Mailing Address - Fax:
Practice Address - Street 1:735 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8493
Practice Address - Country:US
Practice Address - Phone:505-270-4461
Practice Address - Fax:505-865-4134
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator