Provider Demographics
NPI:1427318047
Name:ROSA I VIZCARRA MD PA
Entity type:Organization
Organization Name:ROSA I VIZCARRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VIZCARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-568-5600
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:STE 1111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2516
Mailing Address - Country:US
Mailing Address - Phone:210-568-5600
Mailing Address - Fax:210-568-5686
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:STE 1111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-568-5600
Practice Address - Fax:210-568-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184189205Medicaid
TXTXB160127Medicare PIN