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General NPI Number Information
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NPI Number | 1235561937
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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 | 08/05/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 7501 LAKEVIEW PKWY SUITE 245
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City | ROWLETT
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State | TX
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Zip | 75088-9322
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Country | US
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Telephone | 214-907-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 7501 LAKEVIEW PKWY SUITE 245
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City | ROWLETT
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State | TX
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Zip | 75088-9322
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Country | US
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Telephone | 214-907-3764
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIO ANDINO
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Credential | M.D.
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Telephone | 214-907-3764
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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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