Provider Demographics
NPI:1700196847
Name:DE LUNA, CRISTOPHER MAILUM (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:CRISTOPHER
Middle Name:MAILUM
Last Name:DE LUNA
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3732225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7000950004OtherARCIS HEALTHCARE, LLC GROUP DME PTAN
SC7000950005OtherARCIS HEALTHCARE, LLC GROUP DME PTAN
SCGP6337OtherARCIS HEALTHCARE, LLC GROUP MEDICAID NO.
SC45168OtherARCIS HEALTHCARE, LLC GROUP MULTIPLAN NO.
SC1407270093OtherARCIS HEALTHCARE, LLC GROUP DME NPI
SC1992129563OtherARCIS HEALTHCARE, LLC GROUP DME NPI
SCD043OtherARCIS HEALTHCARE, LLC GROUP MEDICARE PTAN
SC1902246077OtherARCIS HEALTHCARE, LLC GROUP NPI
SCTH2292Medicaid
SC1701OtherGROUP MEDICARE PIN #
SC4042622OtherAETNA PROVIDER NO.
SC983776OtherWELLCARE PROVIDER NO.
SCGP6337OtherARCIS HEALTHCARE, LLC GROUP MEDICAID NO.
SCQ43627D043Medicare PIN