Provider Demographics
NPI:1366913410
Name:CRISOSTOMO, JOSEPH II (RN CRED SCHOOL NURSE)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:CRISOSTOMO
Suffix:II
Gender:M
Credentials:RN CRED SCHOOL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5512
Mailing Address - Country:US
Mailing Address - Phone:661-837-6130
Mailing Address - Fax:661-837-6139
Practice Address - Street 1:1624 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5512
Practice Address - Country:US
Practice Address - Phone:661-837-6130
Practice Address - Fax:661-837-6139
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659406163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool