Healthcare Provider Details

I. General information

NPI: 1528988748
Provider Name (Legal Business Name): ANDRES JAVIER ROSA RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALTOS 215 CALLE NEBLINA CIUDAD JARDIN GURABO
GURABO PR
00778
US

IV. Provider business mailing address

ALTOS 215 CALLE NEBLINA CIUDAD JARDIN GURABO
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-222-9572
  • Fax:
Mailing address:
  • Phone: 787-222-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number842-19-2470
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: