Individual
CRYSTAL MARIE MAKASARASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6840 VIA DEL ORO STE 210, SAN JOSE, CA 95119-1372
(408) 284-2280
Mailing address
450 WAINWRIGHT AVE, SAN JOSE, CA 95128-2163
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95030716
CA
Other
Enumeration date
07/16/2024
Last updated
01/13/2026
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