Provider Demographics
NPI:1689061541
Name:OCTA DEL ROSARIO, CRIS (LAC)
Entity Type:Individual
Prefix:MR
First Name:CRIS
Middle Name:
Last Name:OCTA DEL ROSARIO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:CRIS
Other - Middle Name:
Other - Last Name:DEL ROSARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:100 BLUEGRASS COMMONS BLVD STE 2105
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2198
Mailing Address - Country:US
Mailing Address - Phone:615-439-2900
Mailing Address - Fax:
Practice Address - Street 1:100 BLUEGRASS COMMONS BLVD STE 2105
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2198
Practice Address - Country:US
Practice Address - Phone:615-439-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16435171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist