Cristal Provider Services, LLC.

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

CRISTAL PROVIDER SERVICES, LLC.

Practice address

1002 N Avasolo St
Rio Grande City, TX 78582-2811

Phone

(956) 317-1009

Fax

(956) 488-0525

NPI assigned

Dec 31, 2020

Organization subpart

No

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

Authorized official

Name

Roy Gonzalez

Title

Ceo

Phone

(956) 735-3341

Specialties & licenses 1

Addresses

Other names 1

• Cristal Provider Services, LLC. Former legal business name

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

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1982291316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 N AVASOLO ST",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785822811",
            "telephone_number": "956-317-1009",
            "fax_number": "956-488-0525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 N AVASOLO ST",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785822811",
            "telephone_number": "956-317-1009",
            "fax_number": "956-488-0525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISTAL PROVIDER SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-31",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "956-735-3341"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cristal Provider Services, LLC.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Cristal Provider Services, LLC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Personal Care Attendant in Rio Grande City, TX
• Providers in Rio Grande City, TX by specialty
• Personal Care Attendant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.