Provider Demographics
NPI:1457938821
Name:OROZCO, KRYSTAL MONIQUE
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MONIQUE
Last Name:OROZCO
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 1:9040 TELSTAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2838
Mailing Address - Country:US
Mailing Address - Phone:626-774-5809
Mailing Address - Fax:
Practice Address - Street 1:9040 TELSTAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2838
Practice Address - Country:US
Practice Address - Phone:626-774-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-FTILCM175T00000X
101Y00000X, 171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker