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General NPI Number Information
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NPI Number | 1962695999
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Entity Type | Individual
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Provider Name | ERNESTO JAVIER ROSA DMD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 52 CALLE CARRERAS E
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City | HUMACAO
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State | PR
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Zip | 00791-4269
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Country | US
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Telephone | 787-850-1085
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Fax |
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Provider Business Mailing Address
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Address Line | ECHEGARAY ST. 563 LITHEDA HEIGHTS
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2793
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License Number State | PR
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