Healthcare Provider Details

I. General information

NPI: 1962373654
Provider Name (Legal Business Name): CHRISTIANA G ELLISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 1842
HOUSTON TX
77030-2715
US

IV. Provider business mailing address

6560 FANNIN ST STE 1842
HOUSTON TX
77030-2715
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-2089
  • Fax: 713-794-0576
Mailing address:
  • Phone: 713-790-2089
  • Fax: 713-794-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberPA19496
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: