Provider Demographics
NPI:1326192451
Name:KEUSCH, CRISTINA FREXES (MD)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:FREXES
Last Name:KEUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 GLADES RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6401
Mailing Address - Country:US
Mailing Address - Phone:561-368-9455
Mailing Address - Fax:561-394-8210
Practice Address - Street 1:950 GLADES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6401
Practice Address - Country:US
Practice Address - Phone:561-368-9455
Practice Address - Fax:561-394-8210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66531Medicare UPIN