Provider Demographics
NPI:1548480973
Name:LECAROS-TRINIDAD, CRISTINA M (MD,)
Entity type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:M
Last Name:LECAROS-TRINIDAD
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:M
Other - Last Name:LECAROS-TRINIDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:165 PEPPERS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2363
Mailing Address - Country:US
Mailing Address - Phone:276-223-5400
Mailing Address - Fax:276-223-5454
Practice Address - Street 1:165 PEPPERS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2363
Practice Address - Country:US
Practice Address - Phone:276-223-5400
Practice Address - Fax:276-223-5454
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084392000WVMedicaid
WV0084392000WVMedicaid
WV0552422WVMedicare ID - Type Unspecified