Provider Demographics
NPI:1801339577
Name:FIXICO, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:FIXICO
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 1:800 D STREET 73560
Mailing Address - Street 2:APT #4
Mailing Address - City:OLUSTEE
Mailing Address - State:OK
Mailing Address - Zip Code:73560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 D STREET
Practice Address - Street 2:APT #4
Practice Address - City:OLUSTEE
Practice Address - State:OK
Practice Address - Zip Code:73560
Practice Address - Country:US
Practice Address - Phone:580-318-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist