Provider Demographics
NPI:1316456098
Name:VALLEJO-LOZA, ROSA ALIDYA (DNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ALIDYA
Last Name:VALLEJO-LOZA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N D SALINAS AVE
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-2929
Mailing Address - Country:US
Mailing Address - Phone:956-464-2402
Mailing Address - Fax:
Practice Address - Street 1:307 N D SALINAS AVE
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2929
Practice Address - Country:US
Practice Address - Phone:956-464-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378335901Medicaid
TX618594YLALOtherMEDICARE