Individual
CRISPIN QUISMUNDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12471 NW 15TH PL, APT 16308, SUNRISE, FL 33323-5230
(954) 512-7475
Mailing address
12471 NW 15TH PL, APT 16308, SUNRISE, FL 33323-5230
(954) 512-7475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W2328 08140
AETNA
—
Enumeration date
01/20/2017
Last updated
01/20/2017
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