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General NPI Number Information
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NPI Number | 1457097263
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Entity Type | Individual
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Provider Name | JOSE ALAN DE LA ROSA VAZQUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 913 N DIXIE AVE
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2503
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Country | US
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Telephone | 270-706-5612
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Fax | 270-706-5615
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Provider Business Mailing Address
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Address Line | 835 E MAIN ST UNIT 535
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City | LOUISVILLE
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State | KY
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Zip | 40206-2298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 61386
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 1457097263
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10081505
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License Number State | TX
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