| Doctor Name: | MARIO DE LA ROSA |
| NPI Number: | 1053724765 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 35519 |
| Business Practice Address: | 1505 Calle Del Norte Suite 440 Laredo, TX - 780416036 |
| Business Phone Number: | 9567226221 |
| Business Fax Number: | |
| Mailing Address: | 305 Ne Loop 820, Business Tower 1, Suite 200 HURST |
| State: | TX |
| Postal Code: | 760537209 |
| Phone Number: | 8172928787 |
| Fax Number: | 8177896849 |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | 35519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |