Provider Demographics
NPI:1184126880
Name:ROSALES, JESUS H (ABOC)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:H
Last Name:ROSALES
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E PRICE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2401
Mailing Address - Country:US
Mailing Address - Phone:956-546-3995
Mailing Address - Fax:956-546-2444
Practice Address - Street 1:2120 E PRICE RD STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2401
Practice Address - Country:US
Practice Address - Phone:956-546-3995
Practice Address - Fax:956-546-2444
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC004633156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician