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General NPI Number Information
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NPI Number | 1619073871
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Entity Type | Organization
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Legal Business Name | PERLA ROSA ALICEA
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 100 CALLE FONT MARTELO W STE 320
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City | HUMACAO
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State | PR
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Zip | 00791-3923
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Country | US
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Telephone | 787-850-3485
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Fax | 787-850-3485
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Provider Business Mailing Address
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Address Line | 100 CALLE FONT MARTELO STE 320
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City | HUMACAO
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State | PR
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Zip | 00791-3923
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Country | US
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Telephone | 787-850-3485
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Fax | 787-850-3485
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Authorized Official
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Title or Position | PRESIDENTA
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Name | DR. PERLA ROSA
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Credential | O.D
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Telephone | 787-850-3485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 526
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License Number State | PR
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