Individual
CRYSTAL MICHELLE DE LA CERDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
333 N SANTA ROSA ST, SAN ANTONIO, TX 78207-3108
(210) 704-3718
(210) 704-4520
Mailing address
18318 SNORKEL CV, SAN ANTONIO, TX 78255-3341
(210) 912-2059
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N5644
TX
208M00000X
Hospitalist Physician
N5644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212706001
—
TX
01
—
212706002
CSN
TX
01
—
8CR137
BCBS TX
—
01
—
N5644
TEXAS MEDICAL LICENSE
TX
Enumeration date
05/14/2010
Last updated
11/06/2019
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