Individual
GILES CYRUS CUSTODIO CROCKETT-SANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
9353 BOLSA AVE STE A100, WESTMINSTER, CA 92683-5951
(800) 641-4651
(714) 369-2769
Mailing address
9353 BOLSA AVE STE A100, WESTMINSTER, CA 92683-5951
(800) 641-4651
(714) 369-2769
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95015366
CA
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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