Individual
CRISTISHA GUADAPULE MERCADO LIRIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 GRANITE ST APT 1, GLOUCESTER, MA 01930-3455
(978) 710-1537
Mailing address
25 GRANITE ST APT 1, GLOUCESTER, MA 01930-3455
(978) 710-1537
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100052833033
MASSHEALTH ID (BMC)
MA
01
—
B0118648400
BOSTON MEDICAL CENTER (HNP)
MA
Enumeration date
10/26/2019
Last updated
10/26/2019
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