Provider Demographics
NPI:1184887903
Name:DEL CARPIO TENORIO, CRISTIAN R (MD)
Entity type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:R
Last Name:DEL CARPIO TENORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CRISTIAN
Other - Middle Name:RODOLFO
Other - Last Name:DEL CARPIO TENORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 E OSCEOLA PKWY STE 3200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1616
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:1001 E OSCEOLA PKWY STE 3200
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1616
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-650-1307
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131679207RC0000X
KY46815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100296920Medicaid
FL106093400Medicaid
VAVVD884Medicare PIN