Provider Demographics
NPI:1285988220
Name:POLK, ROSENTHALIA RENEE (CSA)
Entity type:Individual
Prefix:MS
First Name:ROSENTHALIA
Middle Name:RENEE
Last Name:POLK
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:POLK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22307 ELSINORE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1634
Mailing Address - Country:US
Mailing Address - Phone:832-407-4353
Mailing Address - Fax:
Practice Address - Street 1:2743 FERRY LNDG
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4314
Practice Address - Country:US
Practice Address - Phone:713-254-3010
Practice Address - Fax:713-234-7101
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist