Basic Information
| Provider Information | |||||||||
| NPI: | 1740233790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | VIRGINA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 N MACARTHUR BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750623675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722563700 | ||||||||
| FaxNumber: | 8666306348 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 N MACARTHUR BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750623649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725940100 | ||||||||
| FaxNumber: | 9725940111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | J9410 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1668337 01 | 05 | TX | MEDICAID | 035990303 | 05 | TX | MEDICAID | 751365258 | 01 | TAX ID | OTHER |