1366948812 NPI number — CRISTINA AMPARO CARBIA SCHNEIDER DO

Table of content: CRISTINA AMPARO CARBIA SCHNEIDER DO (NPI 1366948812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366948812 NPI number — CRISTINA AMPARO CARBIA SCHNEIDER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARBIA SCHNEIDER
Provider First Name:
CRISTINA
Provider Middle Name:
AMPARO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARBIA SCHNEIDER
Provider Other First Name:
CRISTINA
Provider Other Middle Name:
AMPARO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366948812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1046 MAR WALT DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-243-2229
Provider Business Mailing Address Fax Number:
833-449-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1046 MAR WALT DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-243-2229
Provider Business Practice Location Address Fax Number:
833-449-3901
Provider Enumeration Date:
04/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS20063 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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