MEDICARE: DR. CHRISTINA LEIGH CERVIERI MD

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	174400000X	Specialist	MD035512	DC
2	174400000X	Specialist	D0063046	MD
3	174400000X	Specialist	0101238216	VA

General Provider Information

NPI Number	:	1164427423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA LEIGH CERVIERI MD

Provider Business Mailing Address
First Line	:	PO BOX 8007
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-0507
Country	:	US
Telephone Number	:	208-883-2224
Fax Number	:	208-883-6580

Provider Business Practice Location Address
First Line	:	2301 W A ST
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-4038
Country	:	US
Telephone Number	:	208-883-1135
Fax Number	:	208-892-0174

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/19/2024

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