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NPI Code Detail

MEDICARE: CRISTINA SIFUENTES-AYALA PA-C, MS,RD,IBCLC

MEDICARE: CRISTINA SIFUENTES-AYALA PA-C, MS,RD,IBCLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDT83900TX
2363A00000XPhysician AssistantPA19088TX

General Provider Information

NPI Number : 1285008136
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTINA SIFUENTES-AYALA PA-C, MS,RD,IBCLC
Provider Business Mailing Address
First Line : 2645 NALL ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2645 NALL ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651-4707
Country : US
Telephone Number : 409-210-3336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2015
Last Update Date : 05/07/2025

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