Healthcare Provider Details

I. General information

NPI: 1457551160
Provider Name (Legal Business Name): MISS CHRISTINA MARIA CLOSSON-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CLARKSVILLE ST
PARIS TX
75460-6027
US

IV. Provider business mailing address

5380 COLBIE
RENO TX
75462-5900
US

V. Phone/Fax

Practice location:
  • Phone: 903-737-3122
  • Fax:
Mailing address:
  • Phone: 315-254-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberPF1036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: