Crystal Nerence Gomez Cunanan, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT32788 Issued in CA

Practice address

2586 Buthmann Ave
Tracy, CA 95376-2165

Phone

(209) 832-2273

NPI assigned

Jan 16, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Crystal Nerence De Guia Gomez Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• California Sports Physical Therapy Centers Inc

  • Physical Therapist
  • Albany, CA
  • NPI 1891472965
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255517546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 MARTIN ANTHONY CT",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953776628",
            "telephone_number": "408-799-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2586 BUTHMANN AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953762165",
            "telephone_number": "209-832-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "548 W Eaton Ave",
            "address_purpose": "LOCATION",
            "city": "Tracy",
            "state": "CA",
            "postal_code": "953763422",
            "country_code": "US",
            "telephone_number": "209-836-4765",
            "fax_number": "209-836-9524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUNANAN",
        "first_name": "CRYSTAL NERENCE",
        "middle_name": "GOMEZ",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT32788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL NERENCE",
            "last_name": "GOMEZ",
            "middle_name": "DE GUIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Tracy, CA
• Providers in Tracy, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.