MEDICARE: ROSA VERDE FAMILY HEALTH GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	103T00000X	Psychologist
4	1041C0700X	Clinical Social Worker
5	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74BH	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588774582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSA VERDE FAMILY HEALTH GROUP

Provider Business Mailing Address
First Line	:	PO BOX 12088
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-0088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-472-2090
Fax Number	:	210-472-2062

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARIA DE LOURDES PIZANA
Credential	:	PH.D., LPC
Telephone Number	:	210-472-2090

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/11/2025

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