Provider Demographics
NPI:1700149887
Name:ABUCHAIBE, CRISTINA (DO)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:ABUCHAIBE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:10111 FOREST HILL BLVD RM 110
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6157
Mailing Address - Country:US
Mailing Address - Phone:561-877-5870
Mailing Address - Fax:
Practice Address - Street 1:10111 FOREST HILL BLVD RM 110
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6157
Practice Address - Country:US
Practice Address - Phone:561-877-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT970749312042080P0202X
MO20130046652080P0202X
IDO-09142080P0202X
FLOS205622080P0202X
FLUO 2373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1942664412OtherUNIVERSITY OF UTAH PEDIATRIC CARDIOLOGY