Provider Demographics
NPI:1750817185
Name:ILAGAN, CRISANTA HIPOLITO (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISANTA
Middle Name:HIPOLITO
Last Name:ILAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISANTA
Other - Middle Name:ILAGAN
Other - Last Name:TAPIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 LENOX RD APT 11A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2290
Mailing Address - Country:US
Mailing Address - Phone:510-847-9324
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program