Provider Demographics
NPI:1467645648
Name:FERNANDEZ FALCON, CRISTIAN PABLO (M D)
Entity Type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:PABLO
Last Name:FERNANDEZ FALCON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:903 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-0903
Practice Address - Country:US
Practice Address - Phone:210-358-3985
Practice Address - Fax:210-358-5942
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-002 -003OtherTRICARE/CHAMPUS
NC09400OtherNC BC/BS
VA2180442OtherUHC/MAMSI
VA355581OtherANTHEM - GHENT FAMILY MEDICINE
VAPAROtherVA HEALTH NETWORK
VA9879170OtherAETNA
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
TX282301502Medicaid
VA355583OtherANTHEM - PORTSMOUTH FAMILY MEDICINE
VAPAROtherFIRST HEALTH COMMERCIAL
VA1467645648Medicaid
VA5725950OtherCIGNA
VA10033743OtherSENTARA/OPTIMA
VAPAROtherMULTIPLAN
NC5909400Medicaid
VAPAROtherVA PREMIER HEALTH
NC5909400Medicaid
VAPAROtherUSA MANAGED CARE
VAMC10077Medicare PIN