Provider Demographics
NPI:1659991172
Name:OSSORIO, MARISSA S
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:S
Last Name:OSSORIO
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 1:22924 SILVER CHALICE
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-6004
Mailing Address - Country:US
Mailing Address - Phone:210-687-2784
Mailing Address - Fax:
Practice Address - Street 1:22924 SILVER CHALICE
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-6004
Practice Address - Country:US
Practice Address - Phone:210-687-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353007164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse