Basic Information
| Provider Information | |||||||||
| NPI: | 1073901450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSALES | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 922 E SONTERRA BLVD | ||||||||
| Address2: | APT 8305 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303799308 | ||||||||
| FaxNumber: | 8304014990 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 E SONTERRA BLVD | ||||||||
| Address2: | APT 8305 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303799308 | ||||||||
| FaxNumber: | 8304014990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2015 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 212532 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.