Provider Demographics
NPI:1346487980
Name:LENTINE, CRYSTAL ANGELA (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:ANGELA
Last Name:LENTINE
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5790
Mailing Address - Country:US
Mailing Address - Phone:805-208-4007
Mailing Address - Fax:805-241-6277
Practice Address - Street 1:2848 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-208-4007
Practice Address - Fax:805-241-6277
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist