Provider Demographics
NPI:1437769833
Name:ROGOZEN, AVIVA TZIPORAH (PA-C)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:TZIPORAH
Last Name:ROGOZEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 N BRAESWOOD BLVD APT 331
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2883
Mailing Address - Country:US
Mailing Address - Phone:216-401-9574
Mailing Address - Fax:
Practice Address - Street 1:4550 N BRAESWOOD BLVD APT 331
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-2883
Practice Address - Country:US
Practice Address - Phone:216-401-9574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA13409OtherPHYSICIAN ASSISTANT LICENSE