Individual
ROSEMARIA GENNUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4410 MEDICAL DR, STE 540, SAN ANTONIO, TX 78229-6306
(210) 575-6240
(210) 575-6280
Mailing address
8109 FREDERICKSBURG RD, PHYSICIAN PRACTICE SERVICES, SAN ANTONIO, TX 78229-3311
(210) 575-6240
(210) 575-6280
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
M0411
TX
208000000X
Pediatrics Physician
M0411
TX
2086S0102X
Surgical Critical Care Physician
M0411
TX
2086S0120X
Pediatric Surgery Physician
Primary
M0411
TX
2086X0206X
Surgical Oncology Physician
M0411
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178202105
—
TX
01
—
178202106
CSHCN
TX
01
—
8BX390
BCBS TX
—
Enumeration date
04/25/2006
Last updated
01/27/2022
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