Healthcare Provider Details

I. General information

NPI: 1184126880
Provider Name (Legal Business Name): JESUS H ROSALES ABOC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 E PRICE RD STE B
BROWNSVILLE TX
78521-2401
US

IV. Provider business mailing address

2120 E PRICE RD STE B
BROWNSVILLE TX
78521-2401
US

V. Phone/Fax

Practice location:
  • Phone: 956-546-3995
  • Fax: 956-546-2444
Mailing address:
  • Phone: 956-546-3995
  • Fax: 956-546-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number004633
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: