Provider Demographics
NPI:1790362945
Name:VANDER WOUDE, CRISTINA ESTEFANIA (MD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ESTEFANIA
Last Name:VANDER WOUDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:ESTEFANIA
Other - Last Name:GOMEZ GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:267 GRANT ST DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2870
Mailing Address - Country:US
Mailing Address - Phone:203-384-3000
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST DEPT OF
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2870
Practice Address - Country:US
Practice Address - Phone:203-384-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT78817208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist