Provider Demographics
NPI:1013758770
Name:ZELEDON, CRYSTAL ELIZABETH
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ELIZABETH
Last Name:ZELEDON
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 1:718 PROMONTORY TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1563
Mailing Address - Country:US
Mailing Address - Phone:415-937-2928
Mailing Address - Fax:
Practice Address - Street 1:6735 SIERRA CT STE E
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2618
Practice Address - Country:US
Practice Address - Phone:925-846-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist