Provider Demographics
NPI:1477104768
Name:HUIZAR, CHRISTAL JOY
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:JOY
Last Name:HUIZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:JOY
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19098 FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3617
Mailing Address - Country:US
Mailing Address - Phone:917-324-7919
Mailing Address - Fax:
Practice Address - Street 1:11922 FAIRWAY LAKES DR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8384
Practice Address - Country:US
Practice Address - Phone:392-193-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician