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General NPI Number Information
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NPI Number | 1043640998
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Entity Type | Organization
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Legal Business Name | DE LA ROSA & VELA DENTISTRY
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 7910 TEAK LN STE 207
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1764
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Country | US
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Telephone | 210-804-2212
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Fax | 210-804-2355
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Provider Business Mailing Address
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Address Line | 7910 TEAK LN STE 207
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1764
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Country | US
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Telephone | 210-804-2212
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Fax | 210-804-2355
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PATRICIA DE LA ROSA
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Credential |
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Telephone | 210-804-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14393
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License Number State | TX
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