Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 02002283A | IN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 0102202160 | VA |
NPI | 1255325577 |
---|---|
Provider Name | Dr. Crystal L Hnatko |
First Address | Fairfield, CA 94534-8315 |
Second Address | Fairfield, CA 94534-8315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 10/01/2022 |