Provider Demographics
NPI:1033259072
Name:ROSA, YESENIA BARRETO
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:BARRETO
Last Name:ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 16594
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9036
Mailing Address - Country:US
Mailing Address - Phone:787-612-6958
Mailing Address - Fax:
Practice Address - Street 1:ROAD 635 KM 0.1 BARRIO DOMINGUITO
Practice Address - Street 2:SECTOR GREEN
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5562183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician