Provider Demographics
NPI:1811659907
Name:CRYO HEALTH SPA
Entity type:Organization
Organization Name:CRYO HEALTH SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:925-309-4075
Mailing Address - Street 1:3235 DANVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1913
Mailing Address - Country:US
Mailing Address - Phone:925-309-4075
Mailing Address - Fax:
Practice Address - Street 1:3235 DANVILLE BLVD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1913
Practice Address - Country:US
Practice Address - Phone:925-309-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain