Healthcare Provider Details

I. General information

NPI: 1619035995
Provider Name (Legal Business Name): JOSE MANUEL DE LA ROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE M DE LA ROSA MD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA DEL MAR SUITE 1 ROAD 3 KM 86.5
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 8013
HUMACAO PR
00792-8013
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-0115
  • Fax: 787-850-5711
Mailing address:
  • Phone: 787-285-0115
  • Fax: 787-850-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5123
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: