=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255658738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTINA RAMOS DASTGIRI PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2010
-----------------------------------------------------
Last Update Date | 04/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12335 WAKE UNION CHURCH RD SUITE 206
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-562-1080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12335 WAKE UNION CHURCH RD SUITE 206
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-562-1080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 3393
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------