Provider Demographics
NPI:1215317300
Name:BRISTO, TANGELA
Entity type:Individual
Prefix:MS
First Name:TANGELA
Middle Name:
Last Name:BRISTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681381
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77268-1381
Mailing Address - Country:US
Mailing Address - Phone:713-405-0230
Mailing Address - Fax:
Practice Address - Street 1:1699 ROMANO PARK LN APT 542
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2386
Practice Address - Country:US
Practice Address - Phone:713-405-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4430246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant