Provider Demographics
NPI:1396289112
Name:KARGES, CRYSTAL CLAYTONIA (MS, RDN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CLAYTONIA
Last Name:KARGES
Suffix:
Gender:F
Credentials:MS, RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W CREST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1716
Mailing Address - Country:US
Mailing Address - Phone:760-580-9815
Mailing Address - Fax:
Practice Address - Street 1:150 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5153
Practice Address - Country:US
Practice Address - Phone:760-580-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1057601133V00000X
CAL-48564174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN