MEDICARE: TIMOTHY E. ROSILEZ

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	363AS0400X	Surgical Physician Assistant	2721	TX
2	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1265500201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY E. ROSILEZ

Provider Business Mailing Address
First Line	:	PO BOX 692186
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-2186
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	6314 WILLGUS TRAIL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3947
Country	:	US
Telephone Number	:	281-895-0980
Fax Number	:

Authorized Official
Title or Position	:	SURGEON
Name	:	MR. TIMOTHY ERNESTO ROSILEZ
Credential	:	LSA
Telephone Number	:	832-887-9037

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	05/05/2021

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Directions to “TIMOTHY E. ROSILEZ ” Practice Location

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