Provider Demographics
NPI:1184254427
Name:FISHER, CRYSTAL
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:FISHER
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 1:13547 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-9627
Mailing Address - Country:US
Mailing Address - Phone:760-885-3468
Mailing Address - Fax:
Practice Address - Street 1:13547 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-9627
Practice Address - Country:US
Practice Address - Phone:760-885-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician