Provider Demographics
NPI:1720241482
Name:HARDING, KRYSTAL MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:MARIE
Last Name:HARDING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KRYSTAL
Other - Middle Name:MARIE
Other - Last Name:GENNARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3655 LOMITA BLVD
Mailing Address - Street 2:SUITE 421
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:310-373-7855
Mailing Address - Fax:310-373-7873
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:SUITE 421
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-373-7855
Practice Address - Fax:310-373-7873
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567327163W00000X
CA16548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse