Provider Demographics
NPI:1366697443
Name:NEKUDOVA, KRYSTAL KAYE (PSYD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KAYE
Last Name:NEKUDOVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PORTOLA AVE STE D-180
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1784
Mailing Address - Country:US
Mailing Address - Phone:510-816-0514
Mailing Address - Fax:
Practice Address - Street 1:1874 CATALINA CT
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6416
Practice Address - Country:US
Practice Address - Phone:510-816-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical