Provider Demographics
NPI:1215190277
Name:CRESPO, EMILIO A
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:A
Last Name:CRESPO
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 1:8970 W FLAGLER ST
Mailing Address - Street 2:APT # 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3961
Mailing Address - Country:US
Mailing Address - Phone:305-264-5831
Mailing Address - Fax:
Practice Address - Street 1:7200 NW 7TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2948
Practice Address - Country:US
Practice Address - Phone:305-264-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT65419247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist