Provider Demographics
NPI:1023372950
Name:MOUSSA, CHRISTINE R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 E. GLENN ST.
Mailing Address - Street 2:
Mailing Address - City:TUSCON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1337
Mailing Address - Country:US
Mailing Address - Phone:520-795-7729
Mailing Address - Fax:520-795-4177
Practice Address - Street 1:5150 E. GLENN ST.
Practice Address - Street 2:
Practice Address - City:TUSCON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1337
Practice Address - Country:US
Practice Address - Phone:520-795-7729
Practice Address - Fax:520-795-4177
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR2132390200000X
AZ007132207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ405518Medicaid