Individual
RICARDO CRISTOBAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6320 SOUTHWEST BLVD, SUITE #200, FORT WORTH, TX 76109
(817) 766-5500
(817) 766-5501
Mailing address
6320 SOUTHWEST BLVD., SUITE #200, FORT WORTH, TX 76109
(817) 766-5500
(817) 766-5501
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
M9939
TX
207YX0901X
Otology & Neurotology Physician
M9939
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196011401
—
TX
01
—
196011402
CSHCN MEDICAID
TX
01
—
P00643338
RAIL ROAD MEDICARE
TX
Enumeration date
07/03/2008
Last updated
02/15/2022
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