MEDICARE: ZADHI Y MATIAS ROSA MD

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
1	363AM0700X	Medical Physician Assistant	000762-P.A.	PR
2	390200000X	Student in an Organized Health Care Education/Training Program	16151-I	PR
3	208D00000X	General Practice Physician	23480	PR

General Provider Information

NPI Number	:	1598358913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZADHI Y MATIAS ROSA MD

Provider Business Mailing Address
First Line	:	HC 8 BOX 24678
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00603-9650
Country	:	US
Telephone Number	:	787-431-7594
Fax Number	:

Provider Business Practice Location Address
First Line	:	PR 460 KM 0.2
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00605-4055
Country	:	US
Telephone Number	:	787-658-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	08/21/2023

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