Provider Demographics
NPI:1578659785
Name:CRISTINA V. VALDEZ, MD PA
Entity Type:Organization
Organization Name:CRISTINA V. VALDEZ, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTIE
Authorized Official - Middle Name:SHARIE
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-594-0100
Mailing Address - Street 1:3501 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3636
Mailing Address - Country:US
Mailing Address - Phone:972-594-0100
Mailing Address - Fax:972-594-1979
Practice Address - Street 1:3501 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3636
Practice Address - Country:US
Practice Address - Phone:972-594-0100
Practice Address - Fax:972-594-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077KZOtherBCBS OF TX
TX1668337 01Medicaid
TX1668337 01Medicaid
TX1668337 01Medicaid
TX=========OtherTAX IDENTIFICATION NUMBER