Individual
REGINALD CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
1000 TRANCAS ST, NAPA, CA 94558-2906
(707) 252-4412
Mailing address
1300 ETHAN WAY STE 600, SACRAMENTO, CA 95825-2296
(916) 482-7623
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95017567
CA
363LA2100X
Acute Care Nurse Practitioner
Primary
95017567
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
CA
Enumeration date
06/21/2021
Last updated
08/15/2022
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