Provider Demographics
NPI:1598781940
Name:TAKITA, CRISTIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIANE
Middle Name:
Last Name:TAKITA
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 1:1475 NW 12TH AVE # D-31
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-4337
Mailing Address - Fax:305-243-4363
Practice Address - Street 1:1475 NW 12TH AVE # D-31
Practice Address - Street 2:SUITE 1500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1002
Practice Address - Country:US
Practice Address - Phone:305-243-4337
Practice Address - Fax:305-243-4363
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME788212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49102 ZOtherMEDICARE
FL2569884-00Medicaid
FLH01777Medicare UPIN
FL49102Medicare UPIN