Provider Demographics
NPI:1639585334
Name:GAHAGAN, CRISTAL (LVN)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:GAHAGAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 KRONA LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4718
Mailing Address - Country:US
Mailing Address - Phone:510-435-6972
Mailing Address - Fax:
Practice Address - Street 1:1229 KRONA LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4718
Practice Address - Country:US
Practice Address - Phone:510-435-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274019164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse