Provider Demographics
NPI:1861236622
Name:LANDEROS, ROSA LUZ (APP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LUZ
Last Name:LANDEROS
Suffix:
Gender:F
Credentials:APP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2652 COMAL LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6964
Mailing Address - Country:US
Mailing Address - Phone:956-237-3101
Mailing Address - Fax:
Practice Address - Street 1:1701 TOURNAMENT TRAIL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6564
Practice Address - Country:US
Practice Address - Phone:956-727-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily