Individual
CRYSTAL MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2080 S E ST, SAN BERNARDINO, CA 92408-2773
(909) 388-9191
Mailing address
1705 DUMBARTON AVE, SAN BERNARDINO, CA 92404-6164
(909) 388-9191
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124100383
—
CA
Enumeration date
04/06/2015
Last updated
04/06/2015
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