Healthcare Provider Details

I. General information

NPI: 1841495975
Provider Name (Legal Business Name): IAN CHRISTIE B CIPRIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E AVENUE S
PALMDALE CA
93552-4480
US

IV. Provider business mailing address

43112 15TH ST W
LANCASTER CA
93534-6219
US

V. Phone/Fax

Practice location:
  • Phone: 661-533-7500
  • Fax:
Mailing address:
  • Phone: 877-554-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017428
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number139512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: