Provider Demographics
NPI:1033421128
Name:LICHA-DE-BECERRA, ROSA B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:B
Last Name:LICHA-DE-BECERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S3-4 CALLE 3
Mailing Address - Street 2:VILLAS DE PARANA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6047
Mailing Address - Country:US
Mailing Address - Phone:787-287-2637
Mailing Address - Fax:
Practice Address - Street 1:S3-4 CALLE 3
Practice Address - Street 2:VILLAS DE PARANA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6047
Practice Address - Country:US
Practice Address - Phone:787-287-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6813208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice