Healthcare Provider Details

I. General information

NPI: 1306462023
Provider Name (Legal Business Name): SANTA A ROSADO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANTA A ROSADO ACEVEDO

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 W RANDOL MILL RD STE A
ARLINGTON TX
76012-2564
US

IV. Provider business mailing address

5577 CYPRESS WILLOW BND
FORT WORTH TX
76126-2635
US

V. Phone/Fax

Practice location:
  • Phone: 682-367-2219
  • Fax:
Mailing address:
  • Phone: 817-739-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number14389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: