Provider Demographics
NPI:1295283752
Name:ORTIZ-LYNON, CRISTINA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:ORTIZ-LYNON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HARRAND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3626
Mailing Address - Country:US
Mailing Address - Phone:334-728-2578
Mailing Address - Fax:
Practice Address - Street 1:1227 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3624
Practice Address - Country:US
Practice Address - Phone:334-347-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management