Provider Demographics
NPI:1982034419
Name:WHITEHEAD, CRYSTAL
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 LOVERIDGE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5117
Mailing Address - Country:US
Mailing Address - Phone:925-431-2634
Mailing Address - Fax:925-431-2644
Practice Address - Street 1:2311 LOVERIDGE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:925-431-2634
Practice Address - Fax:925-431-2644
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker