Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 14389 | TX |
NPI | 1306462023 |
---|---|
Provider Name | Santa A Rosado |
First Address | Fort Worth, TX 76132-5009 |
Second Address | Fort Worth, TX 76132-5009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2020 |
Last Update Date | 18/06/2020 |