Provider Demographics
NPI:1053096479
Name:ROSALES, MARISOL
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:SALAS DE LA GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15727 CUTTEN RD APT 818
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3947
Mailing Address - Country:US
Mailing Address - Phone:512-779-5764
Mailing Address - Fax:
Practice Address - Street 1:15727 CUTTEN RD APT 818
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3947
Practice Address - Country:US
Practice Address - Phone:512-779-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician