Provider Demographics
NPI:1316121239
Name:RAYGOZA, CRYSTALBELL
Entity type:Individual
Prefix:
First Name:CRYSTALBELL
Middle Name:
Last Name:RAYGOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12543 PIERCE ST
Mailing Address - Street 2:M
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1700
Mailing Address - Country:US
Mailing Address - Phone:818-987-7058
Mailing Address - Fax:
Practice Address - Street 1:12543 PIERCE ST
Practice Address - Street 2:M
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1700
Practice Address - Country:US
Practice Address - Phone:818-987-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197134Medicaid