MEDICARE: AISLINN ROGALLA

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	65915	MN
2	207Q00000X	Family Medicine Physician	S3286	TX

General Provider Information

NPI Number	:	1902250400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISLINN ROGALLA

Provider Business Mailing Address
First Line	:	PO BOX 746079
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6079
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	1244 UVALDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3708
Country	:	US
Telephone Number	:	281-707-7354
Fax Number	:	832-558-9569

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

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	06/28/2022

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Directions to “ AISLINN ROGALLA ” Practice Location

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