Provider Demographics
NPI:1124135470
Name:DEL RIO, CRISTIAN (PSY D)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:DEL RIO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 SW 87TH AVE
Mailing Address - Street 2:#104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2596
Mailing Address - Country:US
Mailing Address - Phone:305-969-5004
Mailing Address - Fax:305-675-0898
Practice Address - Street 1:7765 SW 87TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2535
Practice Address - Country:US
Practice Address - Phone:305-969-5004
Practice Address - Fax:305-675-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59512Medicare ID - Type Unspecified