Provider Demographics
NPI:1790379717
Name:HONECK, CRYSTAL JOY (HHP, CMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:JOY
Last Name:HONECK
Suffix:
Gender:F
Credentials:HHP, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39442 LONG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4533
Mailing Address - Country:US
Mailing Address - Phone:619-500-6236
Mailing Address - Fax:
Practice Address - Street 1:4002 PARK BLVD STE A1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2689
Practice Address - Country:US
Practice Address - Phone:619-500-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5944225700000X
CA60248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist