Crystal Dawn Omboli, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39365 Issued in CA

Practice address

17752 Sky Park Cir
Suite 230
Irvine, CA 92614-6419

Phone

(800) 561-5207

Fax

(888) 262-5711

NPI assigned

Nov 16, 2012

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

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sakari Wound Specialists, a Professional Nursing Corporation

  dba Vertex Wound Specialists Nursing Corporation

  • Family Nurse Practitioner
  • Redlands, CA
  • NPI 1962368696

  Physical Therapist

  Medicare reassignment NPD
• Global Wound Care Medical Group

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1235831132
  NPD
• Therapists Unlimited

  • Physical Therapy Assistant
  • Irvine, CA
  • NPI 1629400601
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353024000000",
    "number": "1629312459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17752 SKY PARK CIR",
            "address_2": "SUITE 230",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146419",
            "telephone_number": "800-561-5207",
            "fax_number": "888-262-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17752 SKY PARK CIR",
            "address_2": "SUITE 230",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146419",
            "telephone_number": "800-561-5207",
            "fax_number": "888-262-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMBOLI",
        "first_name": "CRYSTAL",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-16",
        "last_updated": "2012-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan L Olson, OTR
• Tiffany Nichole Olson
• Samson Oladipo Oluseye, PHARM.D
• Brandon Olvera
• Shannon Michelle Omalley
• Omeed Ahadiat, M.D.
• Alison Laura Omel, P.A.
• Omid Dianat, DDS, Ms, PC
• Omid Multicultural Institute for Development
• Omid Vesal, MD, Medical Corporation (Irvine Urgent Care)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.