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General NPI Number Information
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NPI Number | 1760244248
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Entity Type | Individual
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Provider Name | ROSAURA DOMENECH GUTIERREZ MSW
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | BUEN SAMARITANO MEDICAL & PROFESSIONAL PLAZA TERCER PISO SUITE 11
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-422-2595
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Fax | 787-551-4119
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Provider Business Mailing Address
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Address Line | 2044 CAMINO REAL
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 939-339-2082
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Fax | 787-551-4119
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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 | 16206
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License Number State | PR
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