MEDICARE: CARISSA RITTBERG DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	2388	TN

General Provider Information

NPI Number	:	1700172723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA RITTBERG DO

Provider Business Mailing Address
First Line	:	559 MEDICAL SQUADRON
Second Line	:	221 THIRD STREET W BLDG 1040
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 MEDICAL SQUADRON
Second Line	:	221 THIRD STREET W BLDG 1040
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150
Country	:	US
Telephone Number	:	210-916-9900
Fax Number	:

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	08/14/2024

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