Provider Demographics
NPI:1629412002
Name:HENRY, CHRISTINA (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:702-843-2440
Mailing Address - Fax:833-749-0349
Practice Address - Street 1:1766 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1945
Practice Address - Country:US
Practice Address - Phone:702-843-2440
Practice Address - Fax:833-749-0349
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1997207Q00000X
FLUO3364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO1997OtherSTATE LICENSE
NV1629412002Medicaid