Crystal Tina Marie Amezquita
Community/Behavioral Health in Salt Lake City, UT. Individual provider (NPI-1).
NPI number1891274429
StatusActive
Last updated in NPPESAug 14, 2018
Details
- NPI
- 1891274429
- Entity type
- Individual (NPI-1)
- Name
- Crystal Tina Marie Amezquita
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 14, 2018
- Last updated
- Aug 14, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
1141 E 3900 S Ste A150Salt Lake City, UT 84124-1215
Phone 888-949-4864
Mailing address
4460 S Highland DrSalt Lake City, UT 84124-3543
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