Provider Demographics
NPI:1427444959
Name:BACA, CRISTINA ANN
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ANN
Last Name:BACA
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 1:1181 MALL DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8105
Mailing Address - Country:US
Mailing Address - Phone:575-522-0766
Mailing Address - Fax:575-522-4659
Practice Address - Street 1:1181 MALL DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8105
Practice Address - Country:US
Practice Address - Phone:575-522-0766
Practice Address - Fax:575-522-4659
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer