Provider Demographics
NPI:1407015829
Name:URRUTIA, KRYSTAL LEANN (TSCASC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LEANN
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:TSCASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 HALLERTAU DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-4835
Mailing Address - Country:US
Mailing Address - Phone:775-233-5958
Mailing Address - Fax:
Practice Address - Street 1:1237 HALLERTAU DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89441-4835
Practice Address - Country:US
Practice Address - Phone:775-233-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant