Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 004633 | DC |
NPI | 1184126880 |
---|---|
Provider Name | Jesus H Rosales |
First Address | Brownsville, TX 78521-2401 |
Second Address | Brownsville, TX 78521-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |