Provider Demographics
NPI:1134582786
Name:DAVID, RITA Y (CSA)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:Y
Last Name:DAVID
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:Y
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSA
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2550
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:550 RIVER PLANTATION DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-3761
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4526246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant