Provider Demographics
NPI:1942970132
Name:CARRADERO, CRISTINA (CSFA)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:CARRADERO
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 MONTEREY CYPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-6480
Mailing Address - Country:US
Mailing Address - Phone:407-314-2815
Mailing Address - Fax:
Practice Address - Street 1:6047 MONTEREY CYPRESS TRL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6480
Practice Address - Country:US
Practice Address - Phone:407-314-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL205118156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist