Provider Demographics
NPI:1154802924
Name:GARMOS, CRYSTAL IMARI (RN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:IMARI
Last Name:GARMOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 N LOOP 1604 E APT 1526
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5678
Mailing Address - Country:US
Mailing Address - Phone:210-843-0362
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1128
Practice Address - Country:US
Practice Address - Phone:210-824-5530
Practice Address - Fax:210-824-5323
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX854884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse