Basic Information
Provider Information | |||||||||
NPI: | 1881695864 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRISCUOLO HIGGINS | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11130 CHRISTUS HILLS | ||||||||
Address2: | 2ND FLOOR, SUITE 201 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782513584 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2107039001 | ||||||||
FaxNumber: | 2107039155 | ||||||||
Practice Location | |||||||||
Address1: | 11130 CHRISTUS HILLS | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 78251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2107039001 | ||||||||
FaxNumber: | 2107039155 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/02/2005 | ||||||||
LastUpdateDate: | 06/12/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M1063 | TX | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1048212 | 01 | TX | BLUELINK ACCESS | OTHER | 1745440-01 | 05 | TX |   | MEDICAID | 7393713 | 01 | TX | AETNA | OTHER | 1745440-02 | 01 | TX | CSHCN MEDICAID | OTHER | 9391864 | 01 | TX | PRIVATE HEALTHCARE SYST | OTHER | 6030526 | 01 | TX | CIGNA | OTHER | 5632580 | 01 | TX | FIRST HEALTH | OTHER | 742806531V | 01 | TX | HUMANA | OTHER | 8J8363 | 01 | TX | BLUECROSSBLUESHIELD TX | OTHER |