Healthcare Provider Details

I. General information

NPI: 1427519164
Provider Name (Legal Business Name): CRISTINA MARIE CASAS LOYOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

17-13 CALLE 10
BAYAMON PR
00959-6605
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2131
  • Fax:
Mailing address:
  • Phone: 787-414-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number022904
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15571I
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22904
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: