Provider Demographics
NPI:1558725697
Name:SOEKAMTO, CHRISTA DANIELLE (MD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:DANIELLE
Last Name:SOEKAMTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S STE 500
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2903
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-513-5613
Practice Address - Street 1:17319 INTERSTATE 35 N STE 303
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1282
Practice Address - Country:US
Practice Address - Phone:808-833-5921
Practice Address - Fax:713-513-5613
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022955207R00000X
TXS5502207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX412337402OtherCSHCN
TX412337401Medicaid