Provider Demographics
NPI:1871353409
Name:ROSALES, VICTORIA CYNTHIA (LAC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CYNTHIA
Last Name:ROSALES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HARVEST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:UHLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78640-3060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 MAIN ST STE 140
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3273
Practice Address - Country:US
Practice Address - Phone:512-648-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC02004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist