Provider Demographics
NPI:1245310689
Name:CONNELLY, ROSINA AVILA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSINA
Middle Name:AVILA
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-4997
Mailing Address - Fax:
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 1N
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-410-5437
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28362208000000X
TXM3197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913506Medicaid
AL51545921OtherBCBS-1504 SPRINGHILL 1600
TX178991901Medicaid
TX178991901Medicaid
AL009913506Medicaid