Provider Demographics
NPI:1316669583
Name:FALCON, CRYSTAL MARLENE (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARLENE
Last Name:FALCON
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARLENE
Other - Last Name:LOZOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SOLE PROPRIETOR
Mailing Address - Street 1:26080 BASE LINE ST APT W183
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-6115
Mailing Address - Country:US
Mailing Address - Phone:909-559-4262
Mailing Address - Fax:
Practice Address - Street 1:26080 BASE LINE ST APT W183
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-6115
Practice Address - Country:US
Practice Address - Phone:909-559-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6348486106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician