MEDICARE: DR. CRISTINA BRECKENRIDGE D.O.

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
2	207R00000X	Internal Medicine Physician	1780925677	VA

General Provider Information

NPI Number	:	1780925677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA BRECKENRIDGE D.O.

Provider Business Mailing Address
First Line	:	12820 SENECA RD
Second Line	:
City	:	IRVING
State	:	NY
Zip	:	14081-9670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2367 NORTH RD
Second Line	:	ST 100 BLDG 584
City	:	HONOLULU
State	:	HI
Zip	:	96860
Country	:	US
Telephone Number	:	808-473-2529
Fax Number	:

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

Provider Enumeration Date	:	03/03/2013
Last Update Date	:	08/30/2023

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