Provider Demographics
NPI:1437942208
Name:GLAAB, CRYSTAL EILEEN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:EILEEN
Last Name:GLAAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 DANVERS CIR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5421
Mailing Address - Country:US
Mailing Address - Phone:805-368-6754
Mailing Address - Fax:
Practice Address - Street 1:894 DANVERS CIR
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5421
Practice Address - Country:US
Practice Address - Phone:805-368-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98020225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist