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General NPI Number Information
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NPI Number | 1033500475
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Entity Type | Organization
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Legal Business Name | ROCKWALL NEUROLOGY, PA
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 9330 POPPY DR SUITE 500B
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City | DALLAS
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State | TX
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Zip | 75218-4621
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Country | US
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Telephone | 469-443-0742
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Fax | 469-443-0501
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Provider Business Mailing Address
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Address Line | 7501 LAKEVEIW PARKWAY SUITE 245
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City | ROWLETT
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State | TX
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Zip | 75088-9326
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Country | US
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Telephone | 469-443-0742
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Fax | 469-443-0501
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIO ANDINO
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Credential | MD
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Telephone | 469-443-0742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | P5324
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License Number State | TX
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