Healthcare Provider Details

I. General information

NPI: 1174823991
Provider Name (Legal Business Name): ROSE SENEGAL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 SHADY COVE CT
PEARLAND TX
77584-1339
US

IV. Provider business mailing address

2302 SHADY COVE CT
PEARLAND TX
77584-1339
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-4624
  • Fax:
Mailing address:
  • Phone: 713-436-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number605607
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number605607
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number605607
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1132841
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: