Provider Demographics
NPI:1841422441
Name:CRYSTAL BAY RADIOLOGY PA
Entity Type:Organization
Organization Name:CRYSTAL BAY RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOWAKOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-735-5356
Mailing Address - Street 1:2568 SWEETGUM WAY W
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3922
Mailing Address - Country:US
Mailing Address - Phone:727-735-5356
Mailing Address - Fax:727-724-6477
Practice Address - Street 1:2568 SWEETGUM WAY W
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3922
Practice Address - Country:US
Practice Address - Phone:727-735-5356
Practice Address - Fax:727-724-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty