Provider Demographics
NPI:1295701878
Name:LOPEZ-ROSARIO, LINDA E (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:E
Last Name:LOPEZ-ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0006
Mailing Address - Country:US
Mailing Address - Phone:956-580-4540
Mailing Address - Fax:956-580-4542
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6045
Practice Address - Country:US
Practice Address - Phone:956-580-4540
Practice Address - Fax:956-580-4542
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133079704Medicaid
TX742764965OtherTAX IDENTIFICATION NUMBER
TXF22522Medicare UPIN