Basic Information
| Provider Information | |||||||||
| NPI: | 1063893618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATRICE | ||||||||
| FirstName: | CRISTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 3RD ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763012245 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 411 N BELKNAP ST | ||||||||
| Address2: | |||||||||
| City: | STEPHENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764013415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172504906 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31741 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | BP10051979 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R5243 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.