Healthcare Provider Details

I. General information

NPI: 1700578374
Provider Name (Legal Business Name): MELANIE ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E5 URB SAN JOSE
AIBONITO PR
00705-4006
US

IV. Provider business mailing address

PO BOX 370634
CAYEY PR
00737-0634
US

V. Phone/Fax

Practice location:
  • Phone: 787-306-6796
  • Fax:
Mailing address:
  • Phone: 787-306-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: