Individual
CRYSTAL RUBY DESTOUCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9114 MERRICK BLVD FL 6, JAMAICA, NY 11432-5363
(718) 674-1000
Mailing address
9114 MERRICK BLVD FL 6, JAMAICA, NY 11432-5363
(718) 262-8190
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
10/12/2021
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