Provider Demographics
NPI:1366723694
Name:DEL ROSARIO, MARICEL
Entity type:Individual
Prefix:MRS
First Name:MARICEL
Middle Name:
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 615
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4018
Mailing Address - Country:US
Mailing Address - Phone:832-484-3756
Mailing Address - Fax:
Practice Address - Street 1:505 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 615
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060
Practice Address - Country:US
Practice Address - Phone:832-484-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4937235Z00000X
TX108293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1851301857Medicaid