Provider Demographics
NPI:1336686047
Name:QUISMUNDO, CRISPIN
Entity Type:Individual
Prefix:
First Name:CRISPIN
Middle Name:
Last Name:QUISMUNDO
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 1:12471 NW 15TH PL
Mailing Address - Street 2:APT 16308
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5230
Mailing Address - Country:US
Mailing Address - Phone:954-512-7475
Mailing Address - Fax:
Practice Address - Street 1:12471 NW 15TH PL
Practice Address - Street 2:APT 16308
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-5230
Practice Address - Country:US
Practice Address - Phone:954-512-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W2328 08140OtherAETNA