Provider Demographics
NPI:1265873228
Name:LATICI, CRISTINA E (MSED)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:E
Last Name:LATICI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W 112TH ST
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3738
Mailing Address - Country:US
Mailing Address - Phone:212-242-2551
Mailing Address - Fax:
Practice Address - Street 1:118 W 112TH ST
Practice Address - Street 2:6B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3738
Practice Address - Country:US
Practice Address - Phone:212-242-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1268694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist