Provider Demographics
NPI:1902341969
Name:ROZAS, ALEXANDER (LAT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ROZAS
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BENVUE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2655
Mailing Address - Country:US
Mailing Address - Phone:337-580-6782
Mailing Address - Fax:
Practice Address - Street 1:1200 BENVUE LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2655
Practice Address - Country:US
Practice Address - Phone:337-580-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3037132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA#LA00046520782OtherHMO, BLUE CROSS BLUE SHIELD