Individual
GILES CYRUS CUSTODIO CROCKETT-SANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 456-8888
Mailing address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 456-8888
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95015366
CA
Other
Enumeration date
10/14/2020
Last updated
07/29/2026
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