Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MT202470 | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | S2382 | TX |
NPI | 1235488719 |
---|---|
Provider Name | Mauricio Francisco La Rosa De Los Rios |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 26/06/2019 |