Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | M0411 | TX |
N | 208000000X | Pediatrician | M0411 | TX |
N | 2086S0102X | Surgical Critical Care | M0411 | TX |
Y | 2086S0120X | Pediatric Surgery | M0411 | TX |
N | 2086X0206X | Surgical Oncologist | M0411 | TX |
NPI | 1093771297 |
---|---|
Provider Name | Rosemaria Gennuso |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-6306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178202105 | (05) | TX |
178202106 | CSHCN (01) | TX |
8BX390 | BCBS TX (01) |