Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 10162 | PR |
NPI | 1023236858 |
---|---|
Provider Name | Dr. Martin Rosa |
First Address | Bayamon, PR 00957 |
Second Address | Bayamon, PR 00957-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |