Provider Demographics
NPI:1558022327
Name:ESPINO JALAPA, CRYSTAL J
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:ESPINO JALAPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:J
Other - Last Name:CHACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9919 WAGON GATE TRL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-2612
Mailing Address - Country:US
Mailing Address - Phone:505-317-8417
Mailing Address - Fax:
Practice Address - Street 1:9919 WAGON GATE TRL SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-2612
Practice Address - Country:US
Practice Address - Phone:505-317-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician