Provider Demographics
NPI:1255088456
Name:GEORGE, KRYSTAL (RDN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S CARNEGIE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4201
Mailing Address - Country:US
Mailing Address - Phone:909-913-4581
Mailing Address - Fax:
Practice Address - Street 1:473 E CARNEGIE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:929-200-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154808106H00000X
CA86107910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist