Individual
MR. FABIAN DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4801 ALBERTA AVE., EL PASO, TX 79905
(915) 545-7333
(915) 545-7338
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04215
TX
363AM0700X
Medical Physician Assistant
P.A. 04215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181191103
—
TX
Enumeration date
03/24/2006
Last updated
05/30/2019
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