Provider Demographics
NPI:1255517546
Name:CUNANAN, CRYSTAL NERENCE GOMEZ (RPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL NERENCE
Middle Name:GOMEZ
Last Name:CUNANAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:CRYSTAL NERENCE
Other - Middle Name:DE GUIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2470 MARTIN ANTHONY CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-6628
Mailing Address - Country:US
Mailing Address - Phone:408-799-7760
Mailing Address - Fax:
Practice Address - Street 1:2586 BUTHMANN AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2165
Practice Address - Country:US
Practice Address - Phone:209-832-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist