MEDICARE: ROSE DERMATOLOGY

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1508697442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE DERMATOLOGY

Provider Business Mailing Address
First Line	:	10630 BRAUN RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2734
Country	:	US
Telephone Number	:	210-838-2909
Fax Number	:	210-905-0121

Provider Business Practice Location Address
First Line	:	10630 BRAUN RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2734
Country	:	US
Telephone Number	:	210-838-2909
Fax Number	:	210-905-0121

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL / OWNER
Name	:	MARY RAMIREZ
Credential	:	MD
Telephone Number	:	210-838-2909

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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Directions to “ROSE DERMATOLOGY ” Practice Location

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