Provider Demographics
NPI:1043064561
Name:SANTOS, ROSEWYNDA DE SAN JOSE (RN)
Entity Type:Individual
Prefix:
First Name:ROSEWYNDA
Middle Name:DE SAN JOSE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSEWYNDA
Other - Middle Name:ARCE
Other - Last Name:DE SAN JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:498 CHALAN PALOSYO
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96910-6427
Mailing Address - Country:US
Mailing Address - Phone:671-475-5760
Mailing Address - Fax:
Practice Address - Street 1:498 CHALAN PALOSYO
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910-6427
Practice Address - Country:US
Practice Address - Phone:671-475-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURX0400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse