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General NPI Number Information
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NPI Number | 1508083346
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Entity Type | Individual
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Provider Name | KRISTY M. MARSILLO DO
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | LA COSTA CENTRE 6300 LA CALMA DRIVE SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78752-3825
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Country | US
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Telephone | 512-452-8533
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Fax |
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Provider Business Mailing Address
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Address Line | 1047 SUNFLOWER TRL
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City | AUSTIN
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State | TX
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Zip | 78745-2783
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Country | US
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Telephone | 716-465-2533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 58002101
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N3868
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License Number State | TX
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