Healthcare Provider Details

I. General information

NPI: 1598083776
Provider Name (Legal Business Name): RUBEN DE LA ROSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

820 S LOUISIANA AVE
WESLACO TX
78596-6836
US

IV. Provider business mailing address

820 S LOUISIANA AVE
WESLACO TX
78596-6836
US

V. Phone/Fax

Practice location:
  • Phone: 956-463-5809
  • Fax: 956-969-1418
Mailing address:
  • Phone: 956-463-5809
  • Fax: 956-969-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: