Individual
KRYSTINA RENAE CARVISO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2025 E AZTEC AVE, GALLUP, NM 87301-4803
(505) 863-3828
Mailing address
PO BOX 594, WINDOW ROCK, AZ 86515-0594
(602) 525-5310
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/17/2018
Last updated
11/15/2022
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