Provider Demographics
NPI:1528602117
Name:PUENTES, KRYSTAL ANGELICA
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANGELICA
Last Name:PUENTES
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 1:1200 GOLDEN KEY CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5820
Mailing Address - Country:US
Mailing Address - Phone:210-698-9844
Mailing Address - Fax:
Practice Address - Street 1:1200 GOLDEN KEY CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5820
Practice Address - Country:US
Practice Address - Phone:210-698-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412312355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant