Healthcare Provider Details

I. General information

NPI: 1366771305
Provider Name (Legal Business Name): MISSY NEDA ROSALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

5219 CITY BANK PKWY SUITE 35
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2770
  • Fax:
Mailing address:
  • Phone: 806-761-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10036169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: