MEDICARE: MR. CHRISTOPHER BUENO DE LA CRUZ

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	225200000X	Physical Therapy Assistant	PTA31205	FL

General Provider Information

NPI Number	:	1871292250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER BUENO DE LA CRUZ

Provider Business Mailing Address
First Line	:	12315 PINFISH RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-9777
Country	:	US
Telephone Number	:	732-397-8178
Fax Number	:

Provider Business Practice Location Address
First Line	:	12601 SORRENTO RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507-8762
Country	:	US
Telephone Number	:	850-908-2570
Fax Number	:

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

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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