Provider Demographics
NPI:1013044122
Name:NEMENZO, CRISTINA CELINO (PT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:CELINO
Last Name:NEMENZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:CERDAN
Other - Last Name:CELINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:612 N RESLER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2369
Mailing Address - Country:US
Mailing Address - Phone:915-584-5683
Mailing Address - Fax:915-584-5657
Practice Address - Street 1:612 N RESLER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2369
Practice Address - Country:US
Practice Address - Phone:915-584-5683
Practice Address - Fax:915-584-5657
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2374225100000X
TX1203130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55508065Medicaid