Provider Demographics
NPI:1457621005
Name:CRIMMINS, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:DEL REAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29325 KIMBERLINA ROAD
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280
Mailing Address - Country:US
Mailing Address - Phone:661-758-4029
Mailing Address - Fax:661-758-4029
Practice Address - Street 1:29325 KIMBERLINA ROAD
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:93250
Practice Address - Country:UM
Practice Address - Phone:661-758-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262644164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse