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General NPI Number Information
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NPI Number | 1801073713
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Entity Type | Organization
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Legal Business Name | CRISTINA LUCIANO M D P A
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 2 NORTH PAVILION PLACE
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City | PENNEY FARMS
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State | FL
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Zip | 32079-9207
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Country | US
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Telephone | 904-349-6344
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | ORANGE PARK
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State | FL
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Zip | 32067-1004
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Country | US
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Telephone | 904-349-6344
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRISTINA LUCIANO
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Credential | M.D.
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Telephone | 904-349-6344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME74563
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License Number State | FL
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