Healthcare Provider Details

I. General information

NPI: 1497537294
Provider Name (Legal Business Name): PAOLA NICOLE CRISTOBAL LUCIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 CALLE SAN ROBERTO
SAN JUAN PR
00926-2759
US

IV. Provider business mailing address

110 CALLE PEDRO ARZUAGA E APT 62
CAROLINA PR
00985-6168
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-6501
  • Fax:
Mailing address:
  • Phone: 787-539-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: