Provider Demographics
NPI:1467710624
Name:MALIA, CHRYSTAL LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:LYNN
Last Name:MALIA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:L
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT080952163W00000X
CT5018367500000X
367H00000X
CANA95000699367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant