Provider Demographics
NPI:1063893618
Name:BEATRICE, CRISTINA
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:BEATRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 11TH STREET
Mailing Address - Street 2:UNIT B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-2245
Mailing Address - Country:US
Mailing Address - Phone:940-263-3000
Mailing Address - Fax:940-263-3018
Practice Address - Street 1:1631 11TH STREET
Practice Address - Street 2:UNIT B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2245
Practice Address - Country:US
Practice Address - Phone:940-263-3000
Practice Address - Fax:940-263-3018
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31741207Q00000X
TXBP10051979207Q00000X
TXR5243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine