MEDICARE: MARISOL ROSALES

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	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1053096479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL ROSALES

Provider Business Mailing Address
First Line	:	15727 CUTTEN RD APT 818
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3947
Country	:	US
Telephone Number	:	512-779-5764
Fax Number	:

Provider Business Practice Location Address
First Line	:	15727 CUTTEN RD APT 818
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-3947
Country	:	US
Telephone Number	:	512-779-5764
Fax Number	:

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

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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Directions to “ MARISOL ROSALES ” Practice Location

Language	Start Address	Practice Location

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