Provider Demographics
NPI:1194856591
Name:ROSA, MURIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MURIEL
Middle Name:
Last Name:ROSA
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 1:113 ALAMO DRIVE
Mailing Address - Street 2:PARKVILLE TERRACE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-790-9241
Mailing Address - Fax:
Practice Address - Street 1:COND LAS TORRES SUR 5 E
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-8810
Practice Address - Fax:787-740-0314
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4431207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601048OtherMMM PUERTO RICO MEDICARE
PR25534OtherTRIPLE S INC LOCAL WELL
PR601048OtherMMM PUERTO RICO MEDICARE
26855Medicare ID - Type Unspecified