De Riese, Cornelia Selma

De Riese, Cornelia Selma is an individual health care provider with primary practice located at 701 W 5Th St , Odessa TX 79763-4206. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery is her primary health care specialty. De Riese, Cornelia Selma can be contacted via phone (432) 335-2222.

Contact Information

Primary practice address
701 W 5Th St Odessa TX 79763-4206
Phone: (432) 335-2222
Fax: (432) 335-1009
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X L6348 Texas
Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery 207VF0040X L6348 Texas

Profile Details

NPI number 1841280716
LBN Legal business name De Riese, Cornelia Selma
Credentials MD, PHD, MBA
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Apr 30th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841280716 NPPES
Texas MEDICAID 111572100
Texas Other 111572101
Texas Other A117
Texas MEDICAID 103816802
Texas MEDICAID 103816803
Texas MEDICAID 84497
Texas MEDICAID 000K5175
Texas Other 83G037
Texas Other 84497
Texas MEDICAID 100048670A
Texas Other 80833Z

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