Healthcare Provider Details

I. General information

NPI: 1477871036
Provider Name (Legal Business Name): ROSANNA VICHUACO ABARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-8826
  • Fax: 915-545-6975
Mailing address:
  • Phone: 915-545-8826
  • Fax: 915-545-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP1-0037757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: