| NPI | 1619552163 |
|---|---|
| Former Name | CRYSTAL BASTEDO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CT 9357) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 9357) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2024-09-20 |