Individual
DR. CHRISTINA DESOUSA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
1400 S MAIN ST STE 502, FORT WORTH, TX 76104-4909
(817) 702-8400
Mailing address
5141 OAKMAN BLVD, DEARBORN, MI 48126-3763
(313) 846-8840
(313) 846-1540
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301088749
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301088749
LICENSE
MI
01
—
V4061
LICENSE
TX
Enumeration date
05/16/2007
Last updated
10/04/2024
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