Provider Demographics
NPI:1245076033
Name:ISHIHARA, CRYSTAL LH
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LH
Last Name:ISHIHARA
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 1:1901 NEWPORT BLVD STE 350-343
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2278
Mailing Address - Country:US
Mailing Address - Phone:323-741-4744
Mailing Address - Fax:
Practice Address - Street 1:12912 BROOKHURST ST STE 420
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4849
Practice Address - Country:US
Practice Address - Phone:323-741-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health