Provider Demographics
NPI:1801059514
Name:CRISTOBAL, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:CRISTOBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 SOUTHWEST BLVD.
Mailing Address - Street 2:SUITE #200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-766-5500
Mailing Address - Fax:817-766-5501
Practice Address - Street 1:6320 SOUTHWEST BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-766-5500
Practice Address - Fax:817-766-5501
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9939207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196011402OtherCSHCN MEDICAID
TXP00643338OtherRAIL ROAD MEDICARE
TX196011401Medicaid