Basic Information
| Provider Information | |||||||||
| NPI: | 1801073713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRISTINA LUCIANO M D P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 380050 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322050550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042912221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1555 KINGSLEY AVE | ||||||||
| Address2: | SUITE #404 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320739207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042150700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2008 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | LUCIANO | ||||||||
| AuthorizedOfficialFirstName: | CRISTINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9042912221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME74563 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.