Healthcare Provider Details

I. General information

NPI: 1780941609
Provider Name (Legal Business Name): PAOLA A ROSA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 09/06/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 RESEARCH BLVD STE 475
AUSTIN TX
78759-5283
US

IV. Provider business mailing address

6210 E US 290
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-338-8181
  • Fax: 512-406-7348
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU2999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: