Individual
MRS. REENU SARA EAPEN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
411 N. WASHINGTON AVE., SUITE 3300, DALLAS, TX 75246-1774
(214) 824-9600
(214) 824-9601
Mailing address
PO BOX 192647, DALLAS, TX 75219-8524
(214) 824-9600
(214) 824-9601
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
L0148
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149789307
—
TX
01
—
8L16162
MEDICARE ID -INDIVIDUAL
TX
Enumeration date
03/16/2006
Last updated
04/25/2011
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