Provider Demographics
NPI:1306044508
Name:DRA ROSA MOSCOSO PINA INC
Entity Type:Organization
Organization Name:DRA ROSA MOSCOSO PINA INC
Other - Org Name:SERVICIOS MEDICOS PREVENTIVOS Y DIAGNOSTICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-851-1381
Mailing Address - Street 1:PMB 206 BOX 5103
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-5103
Mailing Address - Country:US
Mailing Address - Phone:787-851-1381
Mailing Address - Fax:787-851-1381
Practice Address - Street 1:CARRETERA 311 KM 3.4 INT.
Practice Address - Street 2:SECTOR CONDE AVILA
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-1381
Practice Address - Fax:787-851-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10923261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG42907Medicare UPIN