Provider Demographics
NPI:1902497373
Name:CLAVECILLA-RASUL, CHRISTINE JOY
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JOY
Last Name:CLAVECILLA-RASUL
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 1:4501 GOLF VISTA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-3564
Mailing Address - Country:US
Mailing Address - Phone:832-370-9393
Mailing Address - Fax:
Practice Address - Street 1:4501 GOLF VISTA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-3564
Practice Address - Country:US
Practice Address - Phone:832-370-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020647363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care