Provider Demographics
NPI:1447508601
Name:LUZURIAGA, CHRISTINE (MS, CCC-SLP, BCBA,)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LUZURIAGA
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2232
Mailing Address - Country:US
Mailing Address - Phone:407-419-1138
Mailing Address - Fax:
Practice Address - Street 1:2045 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2232
Practice Address - Country:US
Practice Address - Phone:407-419-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB478525103K00000X
FLSA12259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007238100Medicaid