1174876270 NPI number — MRS. CRYSTAL PARRAS FRAUSTO LCSW

Table of content: MRS. CRYSTAL PARRAS FRAUSTO LCSW (NPI 1174876270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174876270 NPI number — MRS. CRYSTAL PARRAS FRAUSTO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAUSTO
Provider First Name:
CRYSTAL
Provider Middle Name:
PARRAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174876270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 CUSTOMER CARE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATWATER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95301-5167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-384-6488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 TEXAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS BANOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93635-3453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-826-1045
Provider Business Practice Location Address Fax Number:
209-826-0952
Provider Enumeration Date:
10/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  67577 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW86177 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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