Healthcare Provider Details

I. General information

NPI: 1609890185
Provider Name (Legal Business Name): RITA V KUSNOOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 VETERANS CIR
BEAUMONT TX
77707-2552
US

IV. Provider business mailing address

2 TWIN CIRCLE DR
BEAUMONT TX
77706-5304
US

V. Phone/Fax

Practice location:
  • Phone: 409-981-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF5994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: