Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R1703 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | R1703 | TX |
N | 208D00000X | General Practice Physician | 017516 | PR |
NPI | 1396979639 |
---|---|
Provider Name | Elisa Basora Rovira |
First Address | Dallas, TX 75235-8286 |
Second Address | Dallas, TX 75207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 02/08/2017 |