MEDICARE: DR. LEVI BONDOC DELROSARIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D9415	TX
2	207V00000X	Obstetrics & Gynecology Physician	D9415	TX

General Provider Information

NPI Number	:	1023343258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEVI BONDOC DELROSARIO M.D.

Provider Business Mailing Address
First Line	:	7410 WAKEFIELD MEADOW LANE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2083
Country	:	US
Telephone Number	:	832-595-9164
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 WAKEFIELD MEADOW LANE
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2083
Country	:	US
Telephone Number	:	832-595-9164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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