Provider Demographics
NPI:1124133723
Name:DEL CRISTO, ROBERTO RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:RAUL
Last Name:DEL CRISTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:RAUL
Other - Last Name:DEL CRISTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4454 OCEAN DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2535
Mailing Address - Country:US
Mailing Address - Phone:239-233-2726
Mailing Address - Fax:361-356-6661
Practice Address - Street 1:4454 OCEAN DRIVE UNIT 4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412
Practice Address - Country:US
Practice Address - Phone:305-300-5465
Practice Address - Fax:361-356-6661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0369207P00000X
FLME0061240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124133723OtherNPI
TX2884025-01-02Medicaid
TXPO 369OtherTEXAS LICENSE
FLME 61240OtherFLORIDA LICENSE
FLF17661Medicare UPIN
TXPO 369OtherTEXAS LICENSE