CRYSTAL BALLEJOS (NPI# 1578947149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578947149 |
| Entity Type | Individual |
| Full Name | CRYSTAL BALLEJOS |
| Practice Address |
1481 Windsor Dr San Bernardino CA 92404-5416 |
| Mailing Address |
850 E Gilbert St San Bernardino CA 92415-0001 |
| Practice Telephone | 9093616470 |
| Mailing Telephone | 9093877200 |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2019-02-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| Y | 225400000X | Rehabilitation Practitioner | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 14677 Merrill Ave, Fontana, CA 92335 | 9516432340 |
| Street Address |
1481 WINDSOR DR |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92404-5416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104950310 | Heather Rene Brown | Counselor | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2007-03-16 |
| 1578170650 | Nancy Elizabeth Ashcraft | Licensed Vocational Nurse | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-09-23 |
| 1598370918 | Jesse Daniel Rodriguez | Case Manager/Care Coordinator | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-09-11 |
| 1619589140 | Michelle Eileen Koperski | Peer Specialist | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-08-17 |
| 1508480583 | Richard Anthony Delarosa | Counselor | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-06-04 |
| 1255955324 | Brenda A Aguayo | Counselor | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-06-03 |
| 1053935353 | Divina Elise Perez | Counselor | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-06-02 |
| 1538782917 | Rochelle Renee Knight | Licensed Vocational Nurse | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-05-20 |
| 1609497098 | Martin E Torres | Licensed Vocational Nurse | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-04-27 |
| 1508493495 | Ebony Rene Venable | Licensed Psychiatric Technician | 1481 Windsor Dr, San Bernardino, CA 92404-5416 | 2020-03-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740849363 | Danniella Alexandra Murillo | Physician Assistant | 2101 North Waterman Ave, San Bernardino, CA 92404 | 2019-06-07 |
| 1902377484 | Shauntel Renee Nelson | Student in an Organized Health Care Education/Training Program | 1481 N. Windsor Dr., San Bernardino, CA 92404 | 2018-12-10 |
| 1487123584 | Garrett M Grigg | Licensed Psychiatric Technician | 1481 N Windsor Dr, San Bernardino, CA 92404 | 2018-11-19 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1043703564 | Samantha Makpaiboonvatana | Optometrist | 1909 N Waterman Ave Ste 3, San Bernardino, CA 92404 | 2018-06-09 |
| 1861981623 | Christopher Windham | Behavior Technician | 2460 Fremontia Dr, San Bernardino, CA 92404 | 2018-05-08 |
| 1891145041 | Cynthia Lusy Gastelum | Marriage & Family Therapist | 1885 E Lynwood Dr Rm Se3, San Bernardino, CA 92404 | 2016-06-20 |
| 1336598259 | Foundation Enterprises LLC | Non-emergency Medical Transport (VAN) | 1663 Date Pl., #30390, San Bernardino, CA 92404 | 2016-06-10 |
| 1881042877 | Helen Ann Thompson | Speech-Language Pathologist | 1311 E. State St., San Bernardo, CA 92404 | 2016-05-31 |
| 1366839938 | Lanecia Richardson | Counselor | 135 Paul Drive, San Rafeal, CA 92404 | 2015-04-22 |
| Find all providers in zip 92404 | ||||
| Taxonomy Code | 225400000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Rehabilitation Practitioner |
| A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811231384 | Lucindy Thomasina Fuller | Rehabilitation Practitioner | 1265 Kendall Dr, San Bernardino, CA 92407 | 2012-11-21 |
| 1053454132 | Matthew Levi Talley Sr. | Rehabilitation Practitioner | 474 E Wabash St, 14, San Bernardino, CA 92404-5351 | 2007-02-15 |
| 1992216840 | Sivanna Warren | Rehabilitation Practitioner | 1950 S Sunwest Ln Ste 200, San Bernardino, CA 92408-3248 | 2017-10-18 |
| 1235488628 | Albert Alcaraz Jr. | Rehabilitation Practitioner | 237 W Mill St, San Bernardino, CA 92408-1403 | 2012-08-31 |
| 1174833255 | Reginald Victor Bias | Rehabilitation Practitioner | 2080 S E St, San Bernardino, CA 92408-2706 | 2010-10-07 |
| 1558670448 | James Henry Phillips Sr. | Rehabilitation Practitioner | 572 N Arrowhead Ave, #200, San Bernardino, CA 92401-1251 | 2010-09-27 |
| 1609184233 | Alejandra Briseno | Rehabilitation Practitioner | 572 N Arrowhead Ave, San Bernardino, CA 92401-1251 | 2010-09-16 |
| 1578881504 | Serene Dickerson | Rehabilitation Practitioner | 431 Mackay Dr, San Bernardino, CA 92408-3222 | 2010-05-14 |
| 1932379104 | Ivette Carolina Rodriguez | Rehabilitation Practitioner | 572 N Arrowhead Ave, San Bernardino, CA 92401-1251 | 2008-03-04 |
| 1144354606 | Erica Valdez | Rehabilitation Practitioner | 1950 S Sunwest Ln, San Bernardino, CA 92408-3258 | 2007-03-15 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92404 |
Please comment or provide details below to improve the information on CRYSTAL BALLEJOS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.