Healthcare Provider Details

I. General information

NPI: 1780740472
Provider Name (Legal Business Name): CHRISTINA ROSSETTI PERDIKIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 02/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 OLD BLANCO RD STE 235
SAN ANTONIO TX
78216-7739
US

IV. Provider business mailing address

PO BOX 55446
HOUSTON TX
77255-5446
US

V. Phone/Fax

Practice location:
  • Phone: 210-314-3476
  • Fax: 210-408-1791
Mailing address:
  • Phone: 210-314-3476
  • Fax: 210-408-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001694
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: