NPIMap

Individual provider Active NPI

Fabian De la Rosa, PA-C

  • Physician Assistant
  • El Paso, TX
National Provider Identifier
1285694026
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04215 Issued in TX
Practice address
4801 Alberta Ave.
El Paso, TX 79905
Phone
(915) 545-7333
Fax
(915) 545-7338
NPI assigned
Mar 24, 2006
Last updated
May 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04215 TX Primary
Medical Physician Assistant 363AM0700X P.A. 04215 TX

Addresses

Primary practice location

4801 Alberta Ave.
El Paso, TX 79905

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other practice location 1

2001 N Oregon St
El Paso, TX 79902-3320
Phone (915) 577-6011

Other identifiers 1

IdentifierTypeStateIssuer
181191103MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000579 TX Practitioner - Physician Assistant 0042277956 Reassigns benefits to 6 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
P.A. 04215TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center El Paso CurrentSince Oct 1, 2008 Accepting new patients
El Paso County Hospital District CurrentSince Jul 18, 2024 Accepting new patients
Texas Tech University Health Sciences Center El Paso CurrentSince Oct 1, 2008 Accepting new patients
El Paso County Hospital District CurrentSince Jul 18, 2024 Accepting new patients
Acute Surgical Care Specialists PLLC Past Accepting new patients
El Paso Southwestern Cardiovascular Associates, P.a. PastSince Mar 11, 1991 Accepting new patients
HCN Ep Horizon City, LLC Past Accepting new patients

Locations

4801 Alberta Ave
El Paso, TX 79905
Phone (915) 215-5200

4815 Alameda Ave
El Paso, TX 79905
Phone (915) 215-6000

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1285694026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 ALBERTA AVE.",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79905",
            "telephone_number": "915-545-7333",
            "fax_number": "915-545-7338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 N Oregon St",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799023320",
            "country_code": "US",
            "telephone_number": "915-577-6011",
            "fax_number": "915-577-7064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA ROSA",
        "first_name": "FABIAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04215",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "P.A. 04215",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181191103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.