Individual
MS. MIRANDA F. CRISTALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601005230
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508023151
—
MI
01
—
5601005230
STATE LICENSE
MI
Enumeration date
05/21/2008
Last updated
06/09/2016
Update your record
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