Provider Demographics
NPI:1700335254
Name:DISLA, CHRISTIAN (AP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:DISLA
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LONGVIEW AVE APT 9201
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5095
Mailing Address - Country:US
Mailing Address - Phone:201-803-9893
Mailing Address - Fax:
Practice Address - Street 1:5401 S KIRKMAN RD
Practice Address - Street 2:#760
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7940
Practice Address - Country:US
Practice Address - Phone:321-332-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3704171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist