Provider Demographics
NPI:1083822100
Name:ROSALES, RUBEN (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E RIDGE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1527
Mailing Address - Country:US
Mailing Address - Phone:956-661-9300
Mailing Address - Fax:956-661-0099
Practice Address - Street 1:1200 E RIDGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1527
Practice Address - Country:US
Practice Address - Phone:956-661-9300
Practice Address - Fax:956-661-0099
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant