MEDICARE: ROSEMARY AMALIA ORNELAZ RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-374584	TX

General Provider Information

NPI Number	:	1053138867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY AMALIA ORNELAZ RBT

Provider Business Mailing Address
First Line	:	11006 RIVER STROLL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2524
Country	:	US
Telephone Number	:	210-857-8697
Fax Number	:

Provider Business Practice Location Address
First Line	:	12758 CIMARRON PATH STE 127
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3498
Country	:	US
Telephone Number	:	855-374-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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