Healthcare Provider Details

I. General information

NPI: 1467004044
Provider Name (Legal Business Name): CRISTINA AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5895 SAN FELIPE ST
HOUSTON TX
77057-3061
US

IV. Provider business mailing address

5895 SAN FELIPE ST
HOUSTON TX
77057-3061
US

V. Phone/Fax

Practice location:
  • Phone: 713-278-8474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: