Basic Information
| Provider Information | |||||||||
| NPI: | 1578659785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRISTINA V. VALDEZ, MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 N MACARTHUR BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750623636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725940100 | ||||||||
| FaxNumber: | 9725941979 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 N MACARTHUR BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750623636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725940100 | ||||||||
| FaxNumber: | 9725941979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAYFIELD | ||||||||
| AuthorizedOfficialFirstName: | ANTIE | ||||||||
| AuthorizedOfficialMiddleName: | SHARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9725940100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 0077KZ | 01 | TX | BCBS OF TX | OTHER | 1668337 01 | 05 | TX | MEDICAID |