| Doctor Name: | MR. JAIME A CRISANTO |
| NPI Number: | 1083838023 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | |
| Business Practice Address: | 9052 Svl Box Victorville, CA - 923955146 |
| Business Phone Number: | 7609279991 |
| Business Fax Number: | 7609479883 |
| Mailing Address: | 14700 Manzanita Park Rd, BEAUMONT |
| State: | CA |
| Postal Code: | 92223 |
| Phone Number: | 9518453155 |
| Fax Number: | 9518458412 |
| NPI Enumeration Date: | 04/12/2007 |
| NPI Last Update Date: | 06/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |