Provider Demographics
NPI:1275543134
Name:MARIA CRISTINA ATIENZA PSC
Entity Type:Organization
Organization Name:MARIA CRISTINA ATIENZA PSC
Other - Org Name:MARIA C ATIENZA MD PSC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ATIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-528-7400
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0545
Mailing Address - Country:US
Mailing Address - Phone:606-528-7400
Mailing Address - Fax:606-528-7449
Practice Address - Street 1:110 ROY KIDD AVE
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1302
Practice Address - Country:US
Practice Address - Phone:606-528-7400
Practice Address - Fax:606-528-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35-001726Medicaid
KY18-3933Medicare ID - Type Unspecified