Provider Demographics
NPI:1649748070
Name:CRYSTAL MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:CRYSTAL MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABADZHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-221-9968
Mailing Address - Street 1:801 W BAY DR STE 314
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3264
Mailing Address - Country:US
Mailing Address - Phone:727-221-9968
Mailing Address - Fax:
Practice Address - Street 1:801 W BAY DR STE 314
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3264
Practice Address - Country:US
Practice Address - Phone:727-221-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-03
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies