Provider Demographics
NPI:1215159108
Name:DEL ROSARIO, GRACIA C (MD)
Entity type:Individual
Prefix:
First Name:GRACIA
Middle Name:C
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 E SOUTHLAKE BLVD # 120-117
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6634
Mailing Address - Country:US
Mailing Address - Phone:817-966-2163
Mailing Address - Fax:817-400-0753
Practice Address - Street 1:900 W ARBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4314
Practice Address - Country:US
Practice Address - Phone:682-304-6000
Practice Address - Fax:682-304-6074
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7521208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194702001Medicaid
TX8AW001OtherBC/BS
TX9915161OtherAETNA
TX9915161OtherAETNA