MEDICARE: DR. ROSE SENEGAL PHD

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	163W00000X	Registered Nurse	605607	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1132841	TX
3	247000000X	Health Information Technician	605607	TX
4	332B00000X	Durable Medical Equipment & Medical Supplies	605607	TX

General Provider Information

NPI Number	:	1174823991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSE SENEGAL PHD

Provider Business Mailing Address
First Line	:	2302 SHADY COVE CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1339
Country	:	US
Telephone Number	:	713-436-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 SHADY COVE CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1339
Country	:	US
Telephone Number	:	713-436-4624
Fax Number	:

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	03/11/2026

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