Healthcare Provider Details

I. General information

NPI: 1922842780
Provider Name (Legal Business Name): CHRISTINA MARIA DAGOSTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLESLEY ST
WESTON MA
02493-1571
US

IV. Provider business mailing address

616 MAIN ST
WATERTOWN MA
02472-2129
US

V. Phone/Fax

Practice location:
  • Phone: 781-786-7000
  • Fax:
Mailing address:
  • Phone: 617-458-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN2386344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: