Healthcare Provider Details

I. General information

NPI: 1942557863
Provider Name (Legal Business Name): HENRY OSSO-RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23410 GRAND RESERVE DR STE 1102
KATY TX
77494-4984
US

IV. Provider business mailing address

8402 FULSHEAR RUN TRCE
RICHMOND TX
77406-2540
US

V. Phone/Fax

Practice location:
  • Phone: 346-387-6568
  • Fax: 346-387-6549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number2130
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberR6068
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2130
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR6068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: