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General NPI Number Information
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NPI Number | 1447699020
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Entity Type | Individual
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Provider Name | ROSA L. HADDOCK-DE-JESUS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | HOSPITAL PEDIATRICO DR ANTONIO ORTIZ BO. MONACILLOS ST. 22 PUERTO RICO MEDICAL CENTER
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City | SAN JUAN
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State | PR
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Zip | 00935-0001
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Country | US
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Telephone | 787-777-3535
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 14772
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City | GURABO
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State | PR
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Zip | 00778-9808
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Country | US
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Telephone | 787-688-0691
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 019292
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License Number State | PR
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