Provider Demographics
NPI:1114074382
Name:ARAMBULA-FALLAD, ROSA (OTR)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:ARAMBULA-FALLAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E SAN PEDRO ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5479
Mailing Address - Country:US
Mailing Address - Phone:956-568-2105
Mailing Address - Fax:956-568-1488
Practice Address - Street 1:1520 E SAN PEDRO ST STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5479
Practice Address - Country:US
Practice Address - Phone:956-568-2105
Practice Address - Fax:956-568-1488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104113225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1574428Medicaid
TX86TT15OtherBLUE CROSS BLUE SHIELD
TX1574428Medicaid