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General NPI Number Information
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NPI Number | 1053796995
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Entity Type | Organization
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Legal Business Name | CRIS ONCOLOGY, LLC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 201 HILDA ST SUITE 33
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City | KISSIMMEE
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State | FL
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Zip | 34741-2320
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Country | US
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Telephone | 407-637-4687
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HILDA ST SUITE 33
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City | KISSIMMEE
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State | FL
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Zip | 34741-2320
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Country | US
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Telephone | 407-637-4687
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RICARDO H CRISOSTOMO
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Credential |
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Telephone | 407-637-4687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME89846
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License Number State | FL
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