Provider Demographics
NPI:1962863613
Name:CAROS, KRYSTAL C (RN)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:C
Last Name:CAROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1101
Mailing Address - Country:US
Mailing Address - Phone:716-857-1282
Mailing Address - Fax:
Practice Address - Street 1:315 CAMINO DEL REMEDIO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-681-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657841163W00000X
CA95080485163W00000X
AZRN194347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse