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NPI Code Detail

MEDICARE: EVELYN ROSA

MEDICARE: EVELYN ROSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist7064PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17064OTHERPRPSYCHOLOGY/COUNSELING

General Provider Information

NPI Number : 1497326854
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN ROSA
Provider Business Mailing Address
First Line : D12 CALLE MIS AMORES
Second Line :
City : CAGUAS
State : PR
Zip : 00725-5821
Country : US
Telephone Number : 787-930-3144
Fax Number :
Provider Business Practice Location Address
First Line : D12 CALLE MIS AMORES
Second Line :
City : CAGUAS
State : PR
Zip : 00725-5821
Country : US
Telephone Number : 787-930-3144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2021
Last Update Date : 07/07/2021

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