Provider Demographics
NPI:1396398079
Name:VASQUEZ CASTELLANOS, ROSA TANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:TANIA
Last Name:VASQUEZ CASTELLANOS
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0367
Mailing Address - Country:US
Mailing Address - Phone:787-951-8978
Mailing Address - Fax:787-818-0900
Practice Address - Street 1:CARRETERA 420 KM 4.4
Practice Address - Street 2:BO PLATA
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-951-8978
Practice Address - Fax:787-818-0900
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21471208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4386909OtherPR LICENSE NUMBER