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General NPI Number Information
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NPI Number | 1063933364
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Entity Type | Organization
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Legal Business Name | NICHOLAS ROSSI MD PA
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 798 ASHLEIGH LN
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City | LANTANA
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State | TX
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Zip | 76226-6430
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Country | US
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Telephone | 214-997-4154
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Fax | 214-997-4154
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Provider Business Mailing Address
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Address Line | 798 ASHLEIGH LANE
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City | DALLAS
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State | TX
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Zip | 76226
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Country | US
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Telephone | 214-997-4154
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | NICHOLAS ROSSI
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Credential |
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Telephone | 214-997-4154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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