MEDICARE: ISIAH BLAKE ROSALES PA

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	363A00000X	Physician Assistant	PA19041	TX

General Provider Information

NPI Number	:	1497553747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIAH BLAKE ROSALES PA

Provider Business Mailing Address
First Line	:	5219 CITY BANK PKWY STE 35
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-3545
Country	:	US
Telephone Number	:	806-775-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8214 MILWAUKEE AVE STE 200
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-0959
Country	:	US
Telephone Number	:	806-475-5544
Fax Number	:

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

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/16/2026

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Directions to “ ISIAH BLAKE ROSALES PA” Practice Location

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