Individual
MS. CRYSTAL MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2198 CAYUGA AVE, SAN FRANCISCO, CA 94112-4023
(650) 784-1567
Mailing address
1216 73RD AVE APT A, OAKLAND, CA 94621-2920
(650) 291-4765
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101Y00000X
—
CA
05
—
171M00000X
—
CA
Enumeration date
10/02/2017
Last updated
11/30/2017
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