Basic Information
| Provider Information | |||||||||
| NPI: | 1407103393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCHESANO | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 MEDICAL PLAZA DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812981133 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 MEDICAL PLAZA DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SHENANDOAH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773803260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812981144 | ||||||||
| FaxNumber: | 2812981133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | P4080 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics | 208000000X | P4080 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 306370303 | 05 | TX | MEDICAID |