Healthcare Provider Details

I. General information

NPI: 1083521504
Provider Name (Legal Business Name): JUAN CARLOS ROSA MADERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 7774 KM 0.4 BO PINAS ABAJO SECTOR LA MORA
COMERIO PR
00782
US

IV. Provider business mailing address

HC-1 BOX 40122
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 787-610-3319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17618
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: