Provider Demographics
NPI:1710188453
Name:ARAYA OSORIO, CHRISTINA MIKI (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MIKI
Last Name:ARAYA OSORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MIKI
Other - Last Name:ARAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1612 BEACHCOMBER DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-7077
Mailing Address - Country:US
Mailing Address - Phone:786-223-6203
Mailing Address - Fax:
Practice Address - Street 1:1612 BEACHCOMBER DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-7077
Practice Address - Country:US
Practice Address - Phone:786-223-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN8838390200000X
FLME101822207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200947270Medicaid
IN200947270Medicaid