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General NPI Number Information
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NPI Number | 1235978412
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Entity Type | Individual
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Provider Name | JORGE CESAR DE LA ROSA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | URB VILLA FONTANA VIA 33 4MN6
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City | CAROINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-257-3068
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Fax |
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Provider Business Mailing Address
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Address Line | COND MONTERREY TAFT 109 APT 5A
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City | SAN JUAN
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State | PR
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Zip | 00911
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Country | US
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Telephone | 787-365-4613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4200
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License Number State | PR
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