Healthcare Provider Details

I. General information

NPI: 1275543134
Provider Name (Legal Business Name): MARIA CRISTINA ATIENZA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ROY KIDD AVE
CORBIN KY
40701-1302
US

IV. Provider business mailing address

PO BOX 545
CORBIN KY
40702-0545
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-7400
  • Fax: 606-528-7449
Mailing address:
  • Phone: 606-528-7400
  • Fax: 606-528-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA C. ATIENZA
Title or Position: OWNER
Credential: MD
Phone: 606-528-7400