Provider Demographics
NPI:1619215365
Name:O MEARA ROSADO DPM PLLC
Entity type:Organization
Organization Name:O MEARA ROSADO DPM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:GONZALEZ MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-503-2020
Mailing Address - Street 1:1397 GEORGE DIETER DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7681
Mailing Address - Country:US
Mailing Address - Phone:915-503-2020
Mailing Address - Fax:915-996-9574
Practice Address - Street 1:1397 GEORGE DIETER DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7681
Practice Address - Country:US
Practice Address - Phone:915-503-2020
Practice Address - Fax:915-996-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
TX1835213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3237802-01Medicaid
TX323780202OtherMEDICAID DME
6817910001Medicare NSC
TX278779Medicare UPIN