Provider Demographics
NPI:1952090425
Name:SAUM, KRYSTAL FAYE (NP)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:FAYE
Last Name:SAUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6164 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3758
Mailing Address - Country:US
Mailing Address - Phone:909-203-9523
Mailing Address - Fax:
Practice Address - Street 1:6833 INDIANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4223
Practice Address - Country:US
Practice Address - Phone:657-346-6319
Practice Address - Fax:951-269-4184
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024925363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health