MEDICARE: DR. CRISTINA RAMOS DASTGIRI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	3393	NC

General Provider Information

NPI Number	:	1255658738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA RAMOS DASTGIRI PH.D.

Provider Business Mailing Address
First Line	:	12335 WAKE UNION CHURCH RD
Second Line	:	SUITE 206
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4527
Country	:	US
Telephone Number	:	919-562-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	12335 WAKE UNION CHURCH RD
Second Line	:	SUITE 206
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4527
Country	:	US
Telephone Number	:	919-562-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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