Provider Demographics
NPI:1427606268
Name:VINUYA, CRYSTAL TECSON
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:TECSON
Last Name:VINUYA
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 1:928 S BROADWAY APT 368
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4560
Mailing Address - Country:US
Mailing Address - Phone:510-331-4744
Mailing Address - Fax:
Practice Address - Street 1:928 S BROADWAY APT 368
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4560
Practice Address - Country:US
Practice Address - Phone:510-331-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program