Healthcare Provider Details

I. General information

NPI: 1801059514
Provider Name (Legal Business Name): RICARDO CRISTOBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 SOUTHWEST BLVD SUITE #200
FORT WORTH TX
76109
US

IV. Provider business mailing address

6320 SOUTHWEST BLVD. SUITE #200
FORT WORTH TX
76109
US

V. Phone/Fax

Practice location:
  • Phone: 817-766-5500
  • Fax: 817-766-5501
Mailing address:
  • Phone: 817-766-5500
  • Fax: 817-766-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberM9939
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM9939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: