Provider Demographics
NPI:1407272834
Name:VIRTUOSA, PLLC
Entity Type:Organization
Organization Name:VIRTUOSA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-878-0090
Mailing Address - Street 1:12602 TOEPPERWEIN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3271
Mailing Address - Country:US
Mailing Address - Phone:210-878-0090
Mailing Address - Fax:210-878-0037
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-878-0090
Practice Address - Fax:210-878-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2024-03-25
Deactivation Date:2024-03-04
Deactivation Code:
Reactivation Date:2024-03-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty