Basic Information
| Provider Information | |||||||||
| NPI: | 1700179645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATEO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | CARMEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATEO | ||||||||
| OtherFirstName: | CHRISTINA CARMEN | ||||||||
| OtherMiddleName: | DIRECTO | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5021 CROSSROADS DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799321635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157905700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5021 CROSSROADS DR | ||||||||
| Address2: | UNIVERSITY MEDICAL CENTER CROSSROADS | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799321635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155217050 | ||||||||
| FaxNumber: | 9155842851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | P9683 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.