Healthcare Provider Details

I. General information

NPI: 1235626409
Provider Name (Legal Business Name): CRYSTAL AVILA-SCHROEDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA CRYSTAL AVILA MD

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SAN PABLO ST SE STE A
ALBUQUERQUE NM
87108-3167
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9242
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2021-0761
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: