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General NPI Number Information
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NPI Number | 1306816327
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Entity Type | Individual
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Provider Name | FLOR DE MARIA CRISOLOGO PA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 209 NE 95TH ST SUITE 9
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2745
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Country | US
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Telephone | 305-751-5454
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Fax | 305-751-1977
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Provider Business Mailing Address
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Address Line | 209 NE 95TH ST SUITE 9
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2745
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Country | US
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Telephone | 305-751-5454
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Fax | 305-751-1977
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2114402
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9100393
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License Number State | FL
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