Healthcare Provider Details

I. General information

NPI: 1609743194
Provider Name (Legal Business Name): PEDRO ROSA NETO MD. PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

UT SOUTHWESTERN MEDICAL CENTER O'DONNELL BRAIN INSTITU 6124 HARRY HINES BLVD ROOM NS9.330, DALLAS TX 75390
DALLAS TX
75390-8823
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax: 214-645-8801
Mailing address:
  • Phone: 214-648-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number48449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: