Healthcare Provider Details

I. General information

NPI: 1528024908
Provider Name (Legal Business Name): JUAN ANGEL DE LA ROSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. CAMINO DEL SOL 420 CAMINO REAL
VEGA BAJA PR
00693-4177
US

IV. Provider business mailing address

URB. CAMINO DEL SOL 420 CAMINO REAL
VEGA BAJA PR
00693-4177
US

V. Phone/Fax

Practice location:
  • Phone: 787-807-5437
  • Fax:
Mailing address:
  • Phone: 787-807-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number2176650
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: