Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | AEC-16-003309 | NY |
NPI | 1437783214 |
---|---|
Provider Name | Salena Rosa |
First Address | Jessup, MD 20794-3978 |
Second Address | College Park, MD 20740-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2020 |
Last Update Date | 27/12/2021 |