Provider Demographics
NPI:1922842228
Name:PATEL, CRYSTAL (MS, MBA, LEP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MS, MBA, LEP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 MADERA RD
Mailing Address - Street 2:#44
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:818-394-0171
Mailing Address - Fax:
Practice Address - Street 1:1302 MADERA RD.
Practice Address - Street 2:#44
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:310-780-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4524103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist