MEDICARE: CRISTAL REYNOSO DELGADO

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558237602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTAL REYNOSO DELGADO

Provider Business Mailing Address
First Line	:	3061 PALM TRACE LANDINGS DR APT 1507
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 PALM TRACE LANDINGS DR APT 1507
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1856
Country	:	US
Telephone Number	:	787-988-8192
Fax Number	:

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

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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