Healthcare Provider Details

I. General information

NPI: 1861236622
Provider Name (Legal Business Name): ROSA LUZ LANDEROS APP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TOURNAMENT TRAIL DR
LAREDO TX
78041-6564
US

IV. Provider business mailing address

2652 COMAL LOOP
LAREDO TX
78046-6964
US

V. Phone/Fax

Practice location:
  • Phone: 956-727-3422
  • Fax:
Mailing address:
  • Phone: 956-237-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1166997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: