Healthcare Provider Details

I. General information

NPI: 1578730388
Provider Name (Legal Business Name): CRISTAL LATANZA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRINITY ST
AUSTIN TX
78712-1765
US

IV. Provider business mailing address

1601 TRINITY ST # Z0900
AUSTIN TX
78712-1765
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7831
  • Fax: 512-324-7835
Mailing address:
  • Phone: 512-324-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number149495
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number303556
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number303556
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberS4271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: