Healthcare Provider Details

I. General information

NPI: 1649761461
Provider Name (Legal Business Name): CRISTINA HOLLOWWA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

3610 CALLE CUERVO NW
ALBUQUERQUE NM
87114-8904
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3709
  • Fax: 505-272-6630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2018-0026
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2018-0026
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: