Provider Demographics
NPI:1235626409
Name:AVILA-SCHROEDER, CRYSTAL (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:AVILA-SCHROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:CRYSTAL
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:306 SAN PABLO ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3167
Mailing Address - Country:US
Mailing Address - Phone:505-272-9242
Mailing Address - Fax:
Practice Address - Street 1:306 SAN PABLO ST SE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3167
Practice Address - Country:US
Practice Address - Phone:505-272-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0761208000000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program