Provider Demographics
NPI:1720254113
Name:AGOSTINELLI, CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:AGOSTINELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15529 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7004
Mailing Address - Country:US
Mailing Address - Phone:305-558-9855
Mailing Address - Fax:
Practice Address - Street 1:15105 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7803
Practice Address - Country:US
Practice Address - Phone:305-558-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108601174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLER861YOtherMEDICARE
FL003669000Medicaid