Healthcare Provider Details

I. General information

NPI: 1649016023
Provider Name (Legal Business Name): CRISTINA HORTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA # 2, AVE. HOSTOS 410, MAYAGUEZ MEDICAL CENTER
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

MAYAGUEZ MEDICAL CTR
MAYAGUEZ PR
00682-1560
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-4585
  • Fax:
Mailing address:
  • Phone: 787-833-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17104I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002682
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: