Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6542 | CA |
NPI | 1003227877 |
---|---|
Provider Name | Krystal Frausto |
First Address | Apple Valley, CA 92307-1221 |
Second Address | Apple Valley, CA 92307-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 22/11/2019 |