Provider Demographics
NPI:1780740472
Name:PERDIKIS, CHRISTINA ROSSETTI (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSSETTI
Last Name:PERDIKIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 55446
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-5446
Mailing Address - Country:US
Mailing Address - Phone:210-314-3476
Mailing Address - Fax:210-408-1791
Practice Address - Street 1:13300 OLD BLANCO RD STE 235
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7739
Practice Address - Country:US
Practice Address - Phone:210-314-3476
Practice Address - Fax:210-408-1791
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001694363A00000X
TXPA05214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant