MEDICARE: CRISTINA PARK M.D.

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	2084P0800X	Psychiatry Physician	ME106235	FL

General Provider Information

NPI Number	:	1669664462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA PARK M.D.

Provider Business Mailing Address
First Line	:	3390 MARY ST STE 116
Second Line	:
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5255
Country	:	US
Telephone Number	:	786-278-7800
Fax Number	:	786-409-4727

Provider Business Practice Location Address
First Line	:	3390 MARY ST
Second Line	:	STE 116
City	:	COCONUT GROVE
State	:	FL
Zip	:	33133-5255
Country	:	US
Telephone Number	:	786-278-7800
Fax Number	:	786-409-4727

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

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	07/21/2022

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