Healthcare Provider Details

I. General information

NPI: 1588190623
Provider Name (Legal Business Name): CRYSTAL BOTELLO RIOJAS MSN APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL BOTELLO MSN APRN FNP-C

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133479
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP133479
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: