Healthcare Provider Details

I. General information

NPI: 1649958232
Provider Name (Legal Business Name): DIANA GONZALES ROSALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 WILSHIRE PL
CORPUS CHRISTI TX
78411-2375
US

IV. Provider business mailing address

642 WILSHIRE PL
CORPUS CHRISTI TX
78411-2375
US

V. Phone/Fax

Practice location:
  • Phone: 361-549-6174
  • Fax:
Mailing address:
  • Phone: 361-549-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number577537
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1179920
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1179920
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: