Provider Demographics
NPI:1164691192
Name:CUETO, CRISTINA V (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:V
Last Name:CUETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 HALL JOHNSON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8766
Mailing Address - Country:US
Mailing Address - Phone:817-267-2678
Mailing Address - Fax:817-354-0854
Practice Address - Street 1:2050 HALL JOHNSON RD
Practice Address - Street 2:STE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8766
Practice Address - Country:US
Practice Address - Phone:817-267-2678
Practice Address - Fax:817-354-0854
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4748208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312431501Medicaid
TX267192YLZNMedicare PIN