Provider Demographics
NPI:1265742514
Name:COLONE, CRYSTAL YVONNE (DHA,DHCS, MPH,MS,PAC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:YVONNE
Last Name:COLONE
Suffix:
Gender:F
Credentials:DHA,DHCS, MPH,MS,PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 DAPPLEGRAY LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-4141
Mailing Address - Country:US
Mailing Address - Phone:951-858-3543
Mailing Address - Fax:
Practice Address - Street 1:3073 DAPPLEGRAY LN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-4141
Practice Address - Country:US
Practice Address - Phone:951-858-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21198363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical