Provider Demographics
NPI:1992804983
Name:MIRROR IMAGE BY CHRISTINE
Entity type:Organization
Organization Name:MIRROR IMAGE BY CHRISTINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORNEJO
Authorized Official - Suffix:
Authorized Official - Credentials:CA CDT
Authorized Official - Phone:210-334-0485
Mailing Address - Street 1:121 WESTERLY PL
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3207
Mailing Address - Country:US
Mailing Address - Phone:210-334-0485
Mailing Address - Fax:
Practice Address - Street 1:121 WESTERLY PL
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3207
Practice Address - Country:US
Practice Address - Phone:210-334-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment