Provider Demographics
NPI:1447296439
Name:KRISTAL CORPORATION
Entity type:Organization
Organization Name:KRISTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-726-0361
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-1629
Mailing Address - Country:US
Mailing Address - Phone:480-726-0361
Mailing Address - Fax:480-726-0363
Practice Address - Street 1:2160 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2487
Practice Address - Country:US
Practice Address - Phone:480-726-0361
Practice Address - Fax:480-726-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5450770001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5450770001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT