1124133723 NPI number — DR. ROBERTO RAUL DEL CRISTO M.D

Table of content: CHRISTINA MARIE CAMERA (NPI 1477056604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124133723 NPI number — DR. ROBERTO RAUL DEL CRISTO M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEL CRISTO
Provider First Name:
ROBERTO
Provider Middle Name:
RAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEL CRISTO
Provider Other First Name:
ROBERTO
Provider Other Middle Name:
RAUL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124133723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4454 OCEAN DR UNIT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78412-2535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-233-2726
Provider Business Mailing Address Fax Number:
361-356-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4454 OCEAN DRIVE UNIT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-300-5465
Provider Business Practice Location Address Fax Number:
361-356-6661
Provider Enumeration Date:
08/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  P0369 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME0061240 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1124133723 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2884025-01-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO 369 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: ME 61240 . This is a "FLORIDA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".