Provider Demographics
NPI:1164427423
Name:CERVIERI, CHRISTINA LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LEIGH
Last Name:CERVIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8007
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-0507
Mailing Address - Country:US
Mailing Address - Phone:208-883-2224
Mailing Address - Fax:208-883-6580
Practice Address - Street 1:2301 W A ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4038
Practice Address - Country:US
Practice Address - Phone:208-883-1135
Practice Address - Fax:208-892-0174
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035512174400000X
MDD0063046174400000X
VA0101238216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH95449Medicare UPIN