Provider Demographics
NPI:1326358227
Name:LINDA LOPEZ-ROSARIO MD PA
Entity Type:Organization
Organization Name:LINDA LOPEZ-ROSARIO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOPEZ-ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-580-4540
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0006
Mailing Address - Country:US
Mailing Address - Phone:956-580-4540
Mailing Address - Fax:956-580-4542
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:SUITE2
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6045
Practice Address - Country:US
Practice Address - Phone:956-580-4540
Practice Address - Fax:956-580-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133079704Medicaid
TXF22522Medicare UPIN