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General NPI Number Information
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NPI Number | 1700257979
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Entity Type | Individual
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Provider Name | ROSANA IVELISSE SANABRIA MSW
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | CARR 417 KM 2.3 LOCAL 3 BO MALPASO
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-243-4641
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Fax |
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Provider Business Mailing Address
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Address Line | HC 5 BOX 10066
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City | MOCA
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State | PUERTO RICO
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Zip | 00676
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Country | UM
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Telephone | 787-243-4641
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12947
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License Number State | PR
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