Individual provider Active NPI

Crystal Joyce Martirez Camagong, FNP-C

  • Family Nurse Practitioner
  • Hesperia, CA
National Provider Identifier
1396523981
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95025526 Issued in CA
Practice address
11919 Hesperia Rd
Hesperia, CA 92345-2158
Phone
(760) 948-1459
NPI assigned
Sep 15, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95025526 CA Primary

Addresses

Primary practice location

11919 Hesperia Rd
Hesperia, CA 92345-2158

Mailing address

15231 Halinor St
Hesperia, CA 92345-1303
Phone (951) 522-3909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240115001616 CA Practitioner - Nurse Practitioner 2365894441 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95025526CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Unicare Community Health Center Inc Current Accepting new patients
Unicare Community Health Center, Inc. CurrentSince Oct 10, 2023 Accepting new patients
Unicare Community Health Center Inc CurrentSince Oct 10, 2023 Accepting new patients

Locations

107 N McKinley St
Corona, CA 92879
Phone (951) 358-0141

11919 Hesperia Rd
Hesperia, CA 92345
Phone (760) 948-1454

1151 E Walnut St
Ontario, CA 91761
Phone (909) 467-0797

437 N Euclid Ave
Ontario, CA 91762
Phone (909) 749-1835

1501 E Holt Ave
Ste A
Pomona, CA 91767
Phone (909) 623-3600

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1396523981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15231 HALINOR ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923451303",
            "telephone_number": "951-522-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 HESPERIA RD",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923452158",
            "telephone_number": "760-948-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMAGONG",
        "first_name": "CRYSTAL JOYCE",
        "middle_name": "MARTIREZ",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95025526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hesperia, CA

Sources for this page

Verify at the official NPI Registry.