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General NPI Number Information
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NPI Number | 1871292250
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Entity Type | Individual
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Provider Name | MR. CHRISTOPHER BUENO DE LA CRUZ
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Gender | Male
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 12601 SORRENTO RD
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City | PENSACOLA
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State | FL
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Zip | 32507-8762
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Country | US
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Telephone | 850-908-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 12315 PINFISH RD
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City | PENSACOLA
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State | FL
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Zip | 32506-9777
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Country | US
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Telephone | 732-397-8178
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA31205
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License Number State | FL
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