Provider Demographics
NPI:1649206087
Name:VIZCARRA, ROSA ISELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ISELA
Last Name:VIZCARRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:ISELA AMAYA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7622 LOUIS PASTEUR DR
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4037
Mailing Address - Country:US
Mailing Address - Phone:210-610-3859
Mailing Address - Fax:210-641-2277
Practice Address - Street 1:7622 LOUIS PASTEUR DR
Practice Address - Street 2:STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4037
Practice Address - Country:US
Practice Address - Phone:210-610-3859
Practice Address - Fax:210-641-2277
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9722207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184189205Medicaid
TX315067YMVUOtherWNI
TXTXB160128Medicare PIN