Provider Demographics
NPI:1407547888
Name:CRIZALDO, CARLO
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:CRIZALDO
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 1:5500 COLUMBIA PIKE APT 526
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5859
Mailing Address - Country:US
Mailing Address - Phone:757-597-3187
Mailing Address - Fax:
Practice Address - Street 1:9455 LORTON MARKET ST STE 201
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1965
Practice Address - Country:US
Practice Address - Phone:703-647-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program