Active NPI
Crystal Kay Gutierrez
- Technician
- Riverside, CA
National Provider Identifier
1154071017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Technician
- License
- L9696
- Practice address
- 5015 Canyon Crest Dr Ste 201
Riverside, CA 92507-6020 - Phone
- (951) 363-9806
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician | 374700000X | L9696 | CA | Primary |
Addresses
Primary practice location
5015 Canyon Crest Dr Ste 201
Riverside, CA 92507-6020
Mailing address
5015 Canyon Crest Dr Ste 201
Riverside, CA 92507-6020
Phone (951) 363-9806
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Www.Electrolysisbycrystal.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L9696 | CA | MD | Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648080000000",
"number": "1154071017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5015 CANYON CREST DR STE 201",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076020",
"telephone_number": "951-363-9806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5015 CANYON CREST DR STE 201",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076020",
"telephone_number": "951-363-9806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "CRYSTAL",
"middle_name": "KAY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-24",
"last_updated": "2022-03-24",
"certification_date": "2022-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "374700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Technician",
"state": "CA",
"license": "L9696",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Www.Electrolysisbycrystal.com",
"affiliation": "N",
"address_1": "5015 Canyon Crest Dr Ste 201",
"city": "Riverside",
"state": "CA",
"country_code": "US",
"postal_code": "925076020",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.