LAURENCE NIKKO CRISOSTOMO


Address: 6617 Tronzano Way, Elk Grove, CA 95757-3057
Phone: 9166276663

LAURENCE NIKKO CRISOSTOMO (NPI# 1760979637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1760979637
Entity Type Individual
Full Name LAURENCE NIKKO CRISOSTOMO
Credential NP
Practice Address 6617 Tronzano Way
Elk Grove
CA 95757-3057
Mailing Address 89 Lincoln Blvd Ste 100
Lincoln
CA 95648-8096
Practice Telephone 9166276663
Mailing Telephone 9165431593
Mailing Fax Number 8774667829
Enumeration Date 2018-04-17
Last Update Date 2018-04-17
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
NP95005664 CA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 6617 TRONZANO WAY
City ELK GROVE
State CA
Zip Code 95757-3057

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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City ELK GROVE
Zip Code 95757

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Dataset Information

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.

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