Healthcare Provider Details

I. General information

NPI: 1205150091
Provider Name (Legal Business Name): ROSELLE C. PETTORINO MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 CENTRAL BLVD STE 300
BROWNSVILLE TX
78520-7539
US

IV. Provider business mailing address

864 CENTRAL BLVD STE 300
BROWNSVILLE TX
78520-7539
US

V. Phone/Fax

Practice location:
  • Phone: 956-541-6311
  • Fax: 956-541-6387
Mailing address:
  • Phone: 956-541-6311
  • Fax: 956-541-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK8420
License Number StateTX

VIII. Authorized Official

Name: ROSELLE C. PETTORINO
Title or Position: GENERAL SURGEON
Credential: MD, PA
Phone: 956-541-6311