Provider Demographics
NPI:1043713423
Name:COSSIOROJAS, PAOLA ALEJANDRA (PA)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:ALEJANDRA
Last Name:COSSIOROJAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:A
Other - Last Name:COSSIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3998 SPITZE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2470
Mailing Address - Country:US
Mailing Address - Phone:702-275-1677
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5002
Practice Address - Country:US
Practice Address - Phone:915-742-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1149081OtherTRICARE, MILITARY