Provider Demographics
NPI:1023592722
Name:GASCA, CRISTINA ROSE (LMT 8642)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ROSE
Last Name:GASCA
Suffix:
Gender:F
Credentials:LMT 8642
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 CARLISLE BLVD NE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2850
Mailing Address - Country:US
Mailing Address - Phone:505-545-7482
Mailing Address - Fax:
Practice Address - Street 1:2921 CARLISLE BLVD NE STE 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2850
Practice Address - Country:US
Practice Address - Phone:505-545-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8648225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist