Healthcare Provider Details

I. General information

NPI: 1205663465
Provider Name (Legal Business Name): SANDRA MARIA DEL ROSARIO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 W 29TH ST
HIALEAH FL
33012-5610
US

IV. Provider business mailing address

6055 NW 105TH CT
DORAL FL
33178-6664
US

V. Phone/Fax

Practice location:
  • Phone: 786-332-9466
  • Fax:
Mailing address:
  • Phone: 786-332-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3093-P.A.
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3093
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTPPA1234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: