Provider Demographics
NPI:1851796528
Name:CLOUD, CRYSTEN SUMMER (MA L AC)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTEN
Middle Name:SUMMER
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MA L AC
Other - Prefix:
Other - First Name:CHRYSTEN
Other - Middle Name:SUMMER
Other - Last Name:CLOUD-FORREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7931 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5107
Mailing Address - Country:US
Mailing Address - Phone:714-625-5798
Mailing Address - Fax:
Practice Address - Street 1:7931 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5107
Practice Address - Country:US
Practice Address - Phone:714-625-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16168171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist