Healthcare Provider Details

I. General information

NPI: 1487901146
Provider Name (Legal Business Name): CRISTINA MARIE SANDERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2012
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST STE 3A105
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

PO BOX 27476
SALT LAKE CITY UT
84127-0476
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2391
  • Fax: 806-743-5687
Mailing address:
  • Phone: 806-743-2898
  • Fax: 806-743-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberP5718
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101022128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: