Provider Demographics
NPI:1952670176
Name:CRISTOBAL, MA. PAZ SALAMAT (MD)
Entity Type:Individual
Prefix:DR
First Name:MA. PAZ
Middle Name:SALAMAT
Last Name:CRISTOBAL
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 1:5603 N SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4148
Mailing Address - Country:US
Mailing Address - Phone:309-713-2373
Mailing Address - Fax:
Practice Address - Street 1:5603 N SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4148
Practice Address - Country:US
Practice Address - Phone:309-713-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.052750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine