MEDICARE: CRISTIAN NARANJO LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MSG012932	PA

General Provider Information

NPI Number	:	1083200406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIAN NARANJO LMT

Provider Business Mailing Address
First Line	:	7410 KEIFFER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1423
Country	:	US
Telephone Number	:	215-900-7491
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 KEIFFER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1423
Country	:	US
Telephone Number	:	215-900-7491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2020
Last Update Date	:	12/19/2020

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