Provider Demographics
NPI:1457551160
Name:CLOSSON-RIVERA, CHRISTINA MARIA
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:CLOSSON-RIVERA
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 1:5380 COLBIE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5900
Mailing Address - Country:US
Mailing Address - Phone:315-254-8989
Mailing Address - Fax:
Practice Address - Street 1:820 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6027
Practice Address - Country:US
Practice Address - Phone:903-737-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF1036242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist