Provider Demographics
NPI:1063493617
Name:VIDOURIA, CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VIDOURIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 FLOYD CURL DR STE 801
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-6470
Mailing Address - Fax:210-767-2259
Practice Address - Street 1:8300 FLOYD CURL DR STE 801
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-6470
Practice Address - Fax:210-767-2259
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM13952081P2900X, 208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188093202Medicaid
TXM1395OtherSTATE MEDICAL LICENSE
TX188093202Medicaid
TX613367Medicare PIN