Provider Demographics
NPI:1386199958
Name:JARA, CHRISTINA ELIZE AQUINO (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA ELIZE
Middle Name:AQUINO
Last Name:JARA
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 1:570 GRANITE PEAK DR APT 302
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4533
Mailing Address - Country:US
Mailing Address - Phone:201-894-3000
Mailing Address - Fax:
Practice Address - Street 1:1020 S CONWELL ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3921
Practice Address - Country:US
Practice Address - Phone:307-265-8300
Practice Address - Fax:307-233-8230
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13022A207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine