Provider Demographics
NPI:1215295589
Name:NAGASAWA, KRYSTLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:ANN
Last Name:NAGASAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRYSTLE
Other - Middle Name:ANN
Other - Last Name:ZIEBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5601 DE SOTO AVE
Mailing Address - Street 2:3RD FLOOR, OB/GYN
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6701
Mailing Address - Country:US
Mailing Address - Phone:818-719-2555
Mailing Address - Fax:
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:3RD FLOOR, OB/GYN
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124353207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology