Healthcare Provider Details

I. General information

NPI: 1073758439
Provider Name (Legal Business Name): ADRIAN GIRALD-ROSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 08/23/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 BO MORA KM 111.3
ISABELA PR
00662
US

IV. Provider business mailing address

3623 AVE MILITAR PMB 226
ISABELA PR
00662-5802
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-7737
  • Fax: 787-830-7839
Mailing address:
  • Phone: 787-830-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13930
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier037454300
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: