Provider Demographics
NPI:1417412859
Name:BLAKELY, ROSAURA OROZCO
Entity Type:Individual
Prefix:
First Name:ROSAURA
Middle Name:OROZCO
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12548 BLAZING STAR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5859
Mailing Address - Country:US
Mailing Address - Phone:915-630-1716
Mailing Address - Fax:
Practice Address - Street 1:10064 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-1801
Practice Address - Country:US
Practice Address - Phone:915-773-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20713702251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics