Provider Demographics
NPI:1528376597
Name:CABANSAG, CRYSTAL CHANEL (PA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHANEL
Last Name:CABANSAG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11240 SAN MATEO DR APT A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3463
Mailing Address - Country:US
Mailing Address - Phone:817-308-5339
Mailing Address - Fax:
Practice Address - Street 1:2226 LILIHA ST STE 302
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1605
Practice Address - Country:US
Practice Address - Phone:808-521-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical