Provider Demographics
NPI:1194425967
Name:FLAVIANI, CRISTIAN
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:FLAVIANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 KELSO DUNES AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7837
Mailing Address - Country:US
Mailing Address - Phone:813-397-7541
Mailing Address - Fax:
Practice Address - Street 1:1350 KELSO DUNES AVE APT 411
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7837
Practice Address - Country:US
Practice Address - Phone:813-397-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner