Provider Demographics
NPI:1669616843
Name:CARRASCO, CRISTINA TREVINO (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:TREVINO
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 SAN RAFAEL
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0523
Mailing Address - Country:US
Mailing Address - Phone:956-451-7697
Mailing Address - Fax:
Practice Address - Street 1:2101 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3228
Practice Address - Country:US
Practice Address - Phone:956-424-3733
Practice Address - Fax:956-424-3734
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist