Provider Demographics
NPI:1316428576
Name:MENA, CRISTOBAL
Entity type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:MENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 EISENHAUER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3703
Mailing Address - Country:US
Mailing Address - Phone:210-646-9576
Mailing Address - Fax:210-653-3997
Practice Address - Street 1:5437 EISENHAUER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3703
Practice Address - Country:US
Practice Address - Phone:210-646-9576
Practice Address - Fax:210-653-3997
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2016283225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant