Provider Demographics
NPI:1508320573
Name:CHAVEZ, ROSEMARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:CHAVEZ
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 1:345 CYPRESS CREEK RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4484
Mailing Address - Country:US
Mailing Address - Phone:512-336-2777
Mailing Address - Fax:512-336-2778
Practice Address - Street 1:250 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1044
Practice Address - Country:US
Practice Address - Phone:512-869-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant